Organization
SUPPORTIVE LIVING CONCEPTS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. QUENTIN M DINKINS (EXECUTIVE DIRECTOR)
(252) 442-3650
Entity
Organization
Contact information
Practice address
1929 ROANOKE AVE, ROANOKE RAPIDS, NC 27870-4333
(252) 537-4888
(252) 537-4811
Mailing address
1929 ROANOKE AVE, ROANOKE RAPIDS, NC 27870-4333
(252) 537-4888
(252) 537-4811
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MHL0604017
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL064017
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408741
—
NC
05
—
8301517B
—
NC
05
—
8301517G
—
NC
Enumeration date
11/13/2006
Last updated
09/11/2025
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