Please review the options below and accurately choose what services you offer.
For multiple selections, please hold the Control key
. Should you have any questions, please
click here
.
Name of Provider:
NPI #:
Name of Practice:
Email Address:
County or Counties Served :
Please Choose
Cabarrus
Davidson
Rowan
Stanly
Union
Other
If another county, please specify
Licensure Type
Services Provided in the Office
Services Provided in the Community
Please Choose
LPC
LCSW
LPA
PhD
Psy D
LMFT
LCAS
MD
PA
NP - Psychiatric
APPCNS
Please Choose
Yes
No
Please Choose
Yes
No
Priority Populations
Ages Treated
Outpatient Treatment
--Please Choose--
MH - Adult
MH - Child
SA – Adult
SA – Child
DD – Adult
DD – Child
--Please Choose--
All Ages
Children
Adolescents
Adult
Geriatrics (55+)
--Please Choose--
Screening and Assessment
Individual Therapy
Group Therapy
Family Therapy
Testing (Licensed Psychologists and LPA only)
Psychiatric Services (MD, PA, and NP only)
Specialized Consultative Services
Ethnic/Cultural
Languages
Treatment Specialty
--Please Choose--
Spanish/Latino
Asian/Pacific Islander
Native American/Alaskan
African American
Caucasian
Gay/Lesbian
Other
If Other, please specify
--Please Choose--
English
Spanish
Hmong
American Sign
Other
If Other, please specify
--Please Choose--
Anxiety Disorders
Autistic Spectrum
Christian/Religious Focus
Cognitive Behavioral Therapy
Couples/Marriage
Court Ordered
Depression
DBT
Eating Disorders
Forensic Evaluations
Gay and Lesbian Issues
Gender Specific
Hearing Impaired
HIV
Mood Disorders
Post Traumatic Stress Disorder
Psychotherapy
Psychoanalysis
Schizophrenias
Substance Abuse Certified
Sexual Aggressive Youth
Sexual Offenders
Sexual Reactive
Testing - Developmental
Testing - Intellectual
Testing - Neuro-Psych testing
Trauma Focused CBT
Traumatic Brain Injury
Visually Impaired
Women’s Issues
If Other, please specify
