Secretary John M. Colmers
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4201 Patterson Avenue

Baltimore, MD 21215

410-764-4732 - Main Number

410-764-4740 - Licensure Coordinator

410-358-1610 - FAX

www.dhmh.state.md.us/bopc/  

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Alcohol & Drug Trainee Applications

   This is a Word file. Microsoft Word is required to view Word files.  Alcohol & Drug Trainee Application      AD#1
    Word Document   Pre-Application Credentials Evaluation for Trainee     AD#2
   This is a Word file. Microsoft Word is required to view Word files.  Alcohol & Drug Trainee Extension Request Form       AD#3  
   This is a Word file. Microsoft Word is required to view Word files.  Alcohol & Drug Trainee Supervisor Information           AD#4   

 Alcohol & Drug Applications

    This is a Word file. Microsoft Word is required to view Word files.  Alcohol & Drug CSC-AD Application   AD#5
    This is a Word file. Microsoft Word is required to view Word files.  Alcohol & Drug CAC-AD Application   AD#6
    This is a Word file. Microsoft Word is required to view Word files.  Alcohol & Drug CPC-AD Application   #AD7
    This is a Word file. Microsoft Word is required to view Word files.  Alcohol & Drug LCADC Application     AD#8
    This is a Word file. Microsoft Word is required to view Word files.  Alcohol & Drug LGADC Application     AD#9
    This is a Word file. Microsoft Word is required to view Word files.  Transfer from LGADC to LCADC        AD#10
    This is a Word file. Microsoft Word is required to view Word files.  Alcohol & Drug Approved Supervisor Application      AD#11
    Word Document   Pre-Application Credentials Evaluation for CSC-AD   AD#12
    Word Document   Pre-Application Credentials Evaluation for CAC-AD    AD#13
    Word Document   Pre-Application Credentials Evaluation for CPC-AD    AD#14
    Word Document   Pre-Application Credentials Evaluation for LCADC and LGADC   AD#15

Professional Counselor Applications

    Word Document   Pre-Application Credentials Evaluation for LCPC and LGPC   PC#1  
    Word Document  LCPC Application     PC#2  
   Word Document   LGPC Application     PC#3
   Word Document  Transfer from LGPC to LCPC     PC#4
   Word Document  Transfer from LGPC to LCPC     PC#4
    Word Document  Supervised Clinical Documentation Form
   Word Document  Educational  requirement information for LCPC and LGPC  

Miscellaneous Forms    

   Word Document  Name Change
   Word Document  Duplicate License Request
       Change of Address     
    Application for Inactive Licensure / Certification Status   
 

 

 

     

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4201 Patterson Avenue, Baltimore, MD 21215, 410-764-4732 - Main Number

410-764-4740 - Licensure Coordinator, 410-358-1610 - FAX

www.dhmh.state.md.us/bopc/ 

 

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 Updated 05/28/2008