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MH Provider Referrals for Teens
Please fill this out if you'd like to be included in a therapeutic referral list for high school students and families. Group practices, clinics, and individuals can be included.
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* Indicates required question
Name
*
Your answer
Type of Provider
*
Therapist
Psychologist
Psychiatrist
Clinic/group practice
Other:
Required
Address/Location
*
Your answer
Specialties
*
Your answer
Insurance Accepted
*
BCBS of NC
BCBS State Health Plan
Medicaid
Cigna
Aetna
Blue Value
United Behavioral Health
TriCare
Magellan
NC Health Choice
Medicare
Veteran's Choice
MedCost
Out of Network
Sliding scale available
Pro bono available
No insurance required (free clinic, etc.)
Other:
Required
Services Offered
*
Individual therapy
Family therapy
Therapeutic groups (please specify in "other")
Art therapy
Medication management
Psychological evaluations
Other:
Required
Phone number (to be given to clients)
Your answer
Email address (to be given to clients)
Your answer
Website
Your answer
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