Healthcare Provider Details

I. General information

NPI: 1093623886
Provider Name (Legal Business Name): SHORE HAVEN YOUTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19444 MAIN ST
MELFA VA
23410-2939
US

IV. Provider business mailing address

19444 MAIN ST
MELFA VA
23410-2939
US

V. Phone/Fax

Practice location:
  • Phone: 757-666-7377
  • Fax:
Mailing address:
  • Phone: 757-666-7377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NAIYM KHIRY TOPPING
Title or Position: CEO
Credential:
Phone: 757-666-7377