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About Clinician
What is your Certification or License # Number?
Where did you obtain your education? Please list degrees and/or certificates received.
Which ethnicity do you identify as?
African-American
How would you describe your gender?(Optional)
What languages do you offer services in?
English
Do you offer interpretation services?
Do you have a religious affiliation?
Spiritual
Preferred Pronouns
She/Her/Hers
About Service
How are you providing mental health services?
Virtual Services, In-Person Services
Client Age
Teenagers (14-19), Adults
Insurance Accepted
What insurances do you offer?
Most Insurances Accepted, also Private Pay, Out of Network, HSA’s, EAP
Specialty Areas
What are your specialty areas?
Depression/Anxiety/AHDH/Grief/PTSD
Message from clinician
Statement to Client
Contact Information
Address
2828 Kraft Ave SE, Ste 269
Phone
Email