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General NPI Number Information
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NPI Number | 1811062474
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Entity Type | Individual
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Provider Name | RICHARD C DAHLQUIST LCSW
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 1141 E MAIN ST SUITE 200
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City | BATESVILLE
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State | AR
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Zip | 72501-3003
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Country | US
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Telephone | 870-793-3199
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Fax | 870-793-3151
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Provider Business Mailing Address
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Address Line | 1141 E MAIN ST SUITE 200
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City | BATESVILLE
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State | AR
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Zip | 72501-3003
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Country | US
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Telephone | 870-793-3199
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Fax | 870-793-3155
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1197-M
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1197-M
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 1197-M
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License Number State | AR
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1197-M
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License Number State | AR
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2162-C
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License Number State | AR
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