Healthcare Provider Details

I. General information

NPI: 1427911353
Provider Name (Legal Business Name): TAILORISTE CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 INTERSTATE NORTH CIR SE STE 200
ATLANTA GA
30339-2384
US

IV. Provider business mailing address

3100 INTERSTATE NORTH CIR SE STE 200
ATLANTA GA
30339-2384
US

V. Phone/Fax

Practice location:
  • Phone: 770-912-5163
  • Fax:
Mailing address:
  • Phone: 770-912-5163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHIRLENE MINETA GORDON
Title or Position: CEO
Credential: DR., LCSW
Phone: 770-912-5163