Addiction Treatment. Continuing Care. Referral Network.

Overview

Alcohol Rehab Treatment and Recovery Programs

Licensed Professional Program

Program Costs, Terms, Conditions

Literature and Resources

Georgia Alcohol Treatment

Fast Facts - Physician

Fast Facts - Assessment

The Problem

The Solution

Producing Optimal Outcomes

Alcohol Treatment Medications

Accelerated On Call

Join Our Referral Network

Literature And Resources

Addiction Treatment. Continuing Care. Referral Network.

Join Our Referral Network

Medical professionals database registration form, required fields.

To be listed in the I Want To Stop Now national referral network of addiction certified medical professionals, please complete the following information and submit this form.

Professional focus*	Physician: Internist Physician: General practitioner Physician: psychiatrist therapist interventionist
First Name*
Middle initial
Last Name*
credentials*
ASAM certified?*	Yes No
Licensed/certified addiction counselor?*	Yes No
Organization*
Years in practice*
Years of specialization in alcohol abuse*
Qualifications*
Briefly describe your philosophy on the treatment of alcohol addiction*
Is your philosophy based on the 12-Step approach?*	Yes No
Street Address 1*
Street Address 2
City*
State/Canadian Province*	-or- Non-US/Canadian Province/Shire/Region:
Country*
Zip Code
Office Phone
Home Phone
Fax Number
Website
Specialty areas	Alcohol addiction Opiate addiction Addiction related pharmacology Rational Emotive Behavioral Therapy Cognitive behavioral therapy Psychotherapy
Modality focus	Individual Group Family Marriage Children
Delivery mode	Outpatient Day programs Inpatient/hospital Residential Halfway house Extended care Acute-care
Range of fees*
Payment methods accepted*	Insurance Private pay
Do you agree to the terms of use?*	Yes No
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