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PAPER APPLICATION INSTRUCTIONS FOR INITIAL …

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9960 Mayland Drive, Suite 300 Henrico, VA 23233-1463 Email: (804) 367-4610 (Tel)(804) 767-6225 (Fax)Revised 02/2021 1 PAPER APPLICATION INSTRUCTIONS FOR INITIAL REGISTRATION OF SUPERVISION FOR CERTIFIED SUBSTANCE ABUSE COUNSELOR (CSAC) Completed APPLICATION : The APPLICATION must have an original signature. To avoid delays, please provide a complete APPLICATION packet. Incomplete packets will not be evaluated by the Credential Reviewer. (Please retain a copy of your completed APPLICATION for your files.) APPLICATION Fee: A fee of $ is required for an APPLICATION to be processed.

• LCP, LCP, LCSW, LMFT, medical doctor or RN and has one of the following: o Holds one of the following national certifications: MAC, NCACII, or AADC; or o Holds a Virginia CSAC Certification; or o Has a minimum of one year experience in substance abuse counseling and at least 100 hours of didactic

  Virginia

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