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Organization
RIVERSIDE COMMUNITY SUPPORTS, INC.
Active
Organization
RIVERSIDE COMMUNITY SUPPORTS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTWANE HECKSTALL BA QP (CEO PRESIDENT)
(252) 862-4111
Entity
Organization
Contact information
Practice address
101 MITCHELL ST N, AHOSKIE, NC 27910-3029
(252) 862-4111
(252) 862-4211
Mailing address
PO BOX 426, POWELLSVILLE, NC 27967-0426
(252) 862-4111
(252) 862-4211
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300813
—
NC
Enumeration date
06/10/2006
Last updated
08/22/2020
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