Provider Demographics
NPI:1811062474
Name:DAHLQUIST, RICHARD C (LCSW)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:C
Last Name:DAHLQUIST
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 E MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-3003
Mailing Address - Country:US
Mailing Address - Phone:870-793-3199
Mailing Address - Fax:870-793-3155
Practice Address - Street 1:1141 E MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-3003
Practice Address - Country:US
Practice Address - Phone:870-793-3199
Practice Address - Fax:870-793-3151
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1197-M101Y00000X, 101YM0800X, 104100000X, 1041C0700X
AR2162-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker