Organization Active NPI

Supportive Living Concepts, Inc.

  • Psychiatry Physician
  • Roanoke Rapids, NC
National Provider Identifier
1730250317
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MHL0604017 Issued in NC
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, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
8301517GMedicaidNC
3408741MedicaidNC
8301517BMedicaidNC

National Provider Directory

National Provider Directory

Locations

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.

Verify at the official NPI Registry.