=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588512164
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GPS OF VIRGINIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2026
-----------------------------------------------------
Last Update Date | 03/19/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3900 WESTERRE PKWY
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23233-1478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-906-9699
-----------------------------------------------------
Fax | 888-483-0118
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39465 W 14 MILE RD
-----------------------------------------------------
City | NOVI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48377-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-906-9699
-----------------------------------------------------
Fax | 888-483-0118
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE DIRECTOR
-----------------------------------------------------
Name | ROBERT CLEMENTE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 877-906-9699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------