Mental Health Resources Submission Form If you are a Mental Health Provider who serves the LGBTQQA Community in Central North Carolina, please consider being included in this listing of available, supportive resources for our Community. We only list Individual Providers who have submitted a written statement that they are LGBT-affirming therapists and have agreed to practice in ways that are affirming of the LGBT community. Your application to be included will be reviewed by our Community Mental Health Resources Project Team who will want to see that statement. You will receive an email message that includes the Statement along with additional information about the process. View the GuidelinesIndividual Provider Name Professional Credentials New Listing? New Provider Update Previously Posted ListingComments to the Project Team Section 1: Personal Contact Information The Mental Health Resources Project Team will contact you periodically to make sure your information is accurate and current. Please provide your personal contact information in this section. This information will NOT be included in your Website Listing unless you provide it again in Section 2.Contact Phone Contact Email Section 2: Website Listing Information County Select County of Practice Wake County Durham County Orange County Chatham County Lee/Harnett Counties Johnston County Franklin/Vance/Granville Counties Eastern NC Western NC Practice Name/Office If different from Provider's NameProvider Address Full address/location on one line pleaseProvider Phone Phone Extension Provider Email Provider Website Facebook Page URL Twitter Page URL LinkedIn Public Page URL Description of Services We will publish the first 400 characters of this description. Please be informational; not promotional.Thanks! Characters remaining: 400 Clients Served All LGBTQ Individuals LGBTQ Families Adults Adolescents Children Cisgender (identifies as birth gender) Transgender and Gender Nonconforming (does not completely identify as birth gender) Lesbians Gays Bisexual men and womenPayment Information We will publish the first 250 characters of this information. Tweet
