Active NPI
Supportive Living Concepts, Inc.
- Psychiatry Physician
- Roanoke Rapids, NC
National Provider Identifier
1730250317
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MHL0604017
- Legal business name
- SUPPORTIVE LIVING CONCEPTS, INC.
- Practice address
- 1929 Roanoke Ave
Roanoke Rapids, NC 27870-4333 - Phone
- (252) 537-4888
- Fax
- (252) 537-4811
- NPI assigned
- Nov 13, 2006
- Last updated
- Sep 11, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Quentin M Dinkins
- Title
- Executive Director
- Phone
- (252) 442-3650
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | MHL064017 | NC | |
| Psychiatry Physician | 2084P0800X | MHL0604017 | NC | Primary |
Addresses
Primary practice location
1929 Roanoke Ave
Roanoke Rapids, NC 27870-4333
Mailing address
1929 Roanoke Ave
Roanoke Rapids, NC 27870-4333
Phone (252) 537-4888
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8301517G | Medicaid | NC | |
| 3408741 | Medicaid | NC | |
| 8301517B | Medicaid | NC |
National Provider Directory
National Provider DirectoryLocations
1929 Roanoke Ave
Roanoke Rapids, NC 27870
Phone (252) 537-4888
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1757548800000",
"number": "1730250317",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1929 ROANOKE AVE",
"city": "ROANOKE RAPIDS",
"state": "NC",
"postal_code": "278704333",
"telephone_number": "252-537-4888",
"fax_number": "252-537-4811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1929 ROANOKE AVE",
"city": "ROANOKE RAPIDS",
"state": "NC",
"postal_code": "278704333",
"telephone_number": "252-537-4888",
"fax_number": "252-537-4811"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SUPPORTIVE LIVING CONCEPTS, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-13",
"last_updated": "2025-09-11",
"status": "A",
"authorized_official_last_name": "DINKINS",
"authorized_official_first_name": "QUENTIN",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "252-442-3650",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "320600000X",
"taxonomy_group": "",
"desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": "NC",
"license": "MHL064017",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NC",
"license": "MHL0604017",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8301517G",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3408741",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8301517B",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Roanoke Rapids, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.