Suggest/Update Provider

I

If you are the Provider or Representative, submit more detailed form below. If are not, submit this form.

Provider Name:

Street Address:

Phone:

(e.g. 210-222-2222)

Fax:

E-mail:

Website:

Contact Person :

Office Hours :


Population Served: (check all that apply)

Adolescent/Youth/Teen

Emancipated Youth

Physically Handicapped

Adolescent/Youth/Teen Only

Gay/Lesbian

Pregnant/Post Partum

Adult

HIV Positive

Psychiatric/Dual Diagnosis

At-risk Populations

Men

Veteran

Children

Men Only

Women

Elderly/Senior

Military/DOD

Women Only


Services Provided: (check all that apply)

Acute Detoxification

Home Visitation

Screening & Assessment

Antabuse Monitoring

Job Readiness

Smoking Cessation

Bilingual

Lab Testing

Speakers Bureau

Community Initiatives

Methadone Maintenance

Standard Outpatient

Day/Evening Treatment

Prevention/Education

Suboxone

EAP Evaluations

Referral & Follow-up

Substance Abuse Research

Halfway House

Residential (Non-Hospital)

Vocational Training


Treatment Strategies: (check all that apply)

12-Step

Inpatient Hospitalization

Recreational Therapy

Continuing Aftercare

Intensive Outpatient

Relapse Prevention

Didactic Education

Intervention

Self-help Groups

Domiciliary Care

Mentor Program

Spiritual/Religious

Family Counseling

Nutritional Counseling

Support Groups

Group Counseling

Peer Counseling

Therapeutic Community

Individual Counseling

Psychotherapy

Work Therapy


Drug Problems Addressed: (check all that apply)

Alcohol

Cocaine/Crack

Methamphetamines

All Drugs (Choose if non-specific)

Hallucinogens

Nicotine

Amphetamines

Herion/Opioids

Poly-Drug

Barbiturates

Inhalants

Prescription

Cannibis

MDMA (Ecstasy)

Tobacco

Program Offered:



Last modified: August 27, 2013.
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