Contact Community Counseling Associates

We look forward to serving you!
This form is to serve assist future clients and connect community leaders making a referral. It is not be used for SEO marketing etc.

Counselor Requested (if applicable) *

* Indicates required field

Name *

First

Last

Gender *

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Email *

Phone Number *

Type of Counseling *

Insurance Company *

If wanting to use BCBS insurance, please describe if you have met deductible or copay amount. *

Please include any relevant information, including your availability (days/time range). *

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Main Line/Counselor On-Call: (214) 509-6888

Fax: (214) 509-6887