Therapists of participants who are in individual, couples or family therapy should download and complete this form quarterly, if that participant had any sessions in the past quarter.
Georgia Professionals Health Program, Inc.
4780 Ashford Dunwoody Rd, Ste 540 #393
Atlanta, Georgia 30338-5504 USA
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(678) 825-3764
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(855) 694-2747
Fax: (855)-781-4082
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