Substance Abuse Treatment Provider Directory

If you are interested in having your name on a regional Substance Abuse Treatment Provider List please complete the form below. We will distribute this list to referral sources such as DCF, schools, medical offices, Court Diversion, Community Justice Centers, families and Mental Health and Substance Abuse Provider Agencies. We want this list to include all substance abuse and mental health clinicians who offer treatment services for substance abuse in their community.

* Indicates required information

1. First Name *This question is required.

2. Last Name *This question is required.

3. Which License(s) or Certification(s) do you currently hold?*

4. Entity you work for (if applicable):

5. Work Address *This question is required.

6. Apt/Suite/Office:

7. City *This question is required.

8. State *This question is required.

9. Zip: *This question is required.

10. Phone Number *This question is required.

11. Your name, address and phone number will be included in the Provider Directory. Do you want your email address included as well?
*This question is required.

12. Gender
*This question is required.

14. Is your business handicap accessible? *This question is required.

15. Languages Spoken:

16. Website

17. Which insurance do you accept? *This question is required.

Vermont Medicaid
Medicare
Blue Cross Blue Shield
MVP
Cigna
Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

18. For which county(s) do you provide treatment services? (Please check all that apply) *This question is required.

19. Which populations do you treat for substance abuse? (please choose all that apply) *This question is required.

20. Please provide a description of the services you provide, including any age appropriate substance abuse assessments and treatment approaches used. This description will be included in the Provider List for referral sources and prospective clients to read. *This question is required.

If you have comments or questions about this Provider List, please contact Amy Danielson at amy.danielson@vermont.gov.