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Add Your Provider Profile

Thank you for your interest in the Direct-Connect.info Provider Listing System! This system, as you may have already discovered is geared towards connecting Behavioral Health Professionals with those who may be in need of assistance. Direct-Connect.info offers the service to both providers and the public free of charge. When your listing is approved, you'll receive an email asking you to login to the web site, update your profile and add any information that might be missing. Then all you have to do is activate your listing which will allow your listing be seen in the search results.

As a member of Direct-Connect.info, you are invited to enhance your listing which allows you to specify the same information as in our standard listing and more! With the enhanced listing you can add information such as accepted health insurance, resume data, ability to publish documents, a www.direct-connect.info/yourname URL, personalized page layouts, photos and more. At this time, there is no additional charge for an enhanced listing.
[See a Sample Enhanced Listing]

Just select the type of listing you would like to have in the form below.

Instructions: Note that all fields with a red asterisk are required for addition to the provider database. There will be a delay before your listing will appear on our web site so that your credentials can be verified. After verification, you will be notified by e-mail, given a log-in ID and password, and directed to a web page where you can complete the entry of your professional profile. BE CERTAIN THAT YOU CLICK ON THE "SUBMIT MY PROFILE" BUTTON AT THE BOTTOM OF THE PAGE AFTER ENTERING YOUR INFORMATION OR NOTHING WILL BE SAVED.


ENTER YOUR PASSWORD:* (at least 6 characters long)
VERIFY YOUR PASSWORD:*  
First Name:*  
Last Name:*  
Middle Initial:
Last Degree Completed:*  
Office Address:*  
Office Address(Cont.):  
City:*  
State/Province:*  
Zipcode/Postal Code:*  
Office Phone:*  
Email:*  
State/Province Certified/Licensed As:*  
  Psychiatrist   Psychologist
  Social Worker   Counselor
  Marriage and Family Therapist   Psychiatric Nurse Practitioner
  Substance Abuse Counselor  
(inclusion in this directory requires the appropriate licensure or certification in the state/province/country of residence for each professional listed.)
License/Certification Number:*  
License/Certification State/Province:*  
Philosophy of Care:  
Ages Served:  
  infant (0-2)   young child (3-6)   child (7-12)
  adolescent (13-19)   young adult (20-24)   adult (25-64)
  senior (65+)    
Clinical Specialties:  [Red (second) checkboxes indicate special expertise]
  abuse issues (victims)   adjustment problems
  addiction / substance abuse   AIDS/HIV
  anger/aggressive issues   adjustment to illness
  anxiety disorders   attention deficit-hyperactivity disorders
  mood disorders/depression/bipolar   bereavement/grief issues
  obsessive compulsive disorder   biofeedback
  pain management   brain injuries or illness
  personality disorders   cancer issues
  physical disabilities   career evaluation and counseling
  post-traumatic stress syndrome (PTSD)   child/adolescent concerns
  psychoeducational evaluations   compulsive spending
  psychophysiological disorders   couples/relational issues
  schizophrenia/psychosis   developmental disorders
  sexual abuse (perpetrator issues)   disability determination and intervention
  sexual abuse (victims)   dissociative disorders
  sexual addiction   divorce and custody issues
  sexual dysfunction   eating disorders/weight management
  sexual orientation/identity disorders   ethnic and cultural issues
  sleep disorders   family relationship concerns
  smoking cessation   gambling
  spiritual/religious concerns   gay, lesbian and bisexual issues
  sports psychology   geriatrics/aging
  stress management   impaired professionals
  trauma (physical)   impulse control disorders
  women's issues   learning disorders
  workplace issues/occupational health   men's issues
Substance Abuse Experience & Expertise:  
Credential(s) as Substance Abuse Professional:   Certificate of Proficiency in the Treatment of Alcohol
        and Other Psychoactive Substance Use Disorders from APA

 NAADAC Member
 State/Province Certified/Licensed as a Substance Abuse Counselor
 SAP (Substance Abuse Professional) from Department of Transportation

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