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APPLICATION PACKET - CCE

Board Certified-Telemental Health APPLICATION 1 revised January 2017 APPLICATION PACKET This APPLICATION form is interactive. Download the form to your computer to fill it out. 3 TERRA CE WAY GREENSBORO, NC 27403-3660 USA TEL: +1 FAX: +1 The Board Certified TeleMental Health Provider (BC-TMH) mark is a trademark of the Center for Credentialing & Education, CCE and NBCC are registered trade and service marks of the National Board for Certified Counselors, Inc. The Center f or Credentialing & Education, Inc. (CCE) values diversity . There are no barriers to credentialing on the basis of gender, race, creed, age, sexual orientation or national origin.

ELIGIBILITY REQUIREMENTS LISW (Licensed Independent Social Worker) LISW-CP (Licensed Independent Social Worker- Clinical

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