Member Directory Form Complete the below form to be included in the member directory. First Name Last Name Email State City Areas of Interest Practice Area(s) Academia / PACT Team Medical Director Administration / Management Assertive Community Treatment Team Community Mental Health Center Consultant FQHC / Integrated Primary Care Inpatient Hospital Unit Jail / Prison Outpatient Addictions Program Outpatient Clinic Private Practice Residential Treatment Short Term Residential Crisis Center Years in Practice Are you interested in the joining the mentor/mentee program? Not at this time Yes, as a mentor Yes, as a mentee Thank you!
