Member-form - Psychoanalytic Center of the Carolinas

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First Name

Last Name

Email

Address

Street Address *

City *

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Zipcode *

Are you currently seeing patients? *

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APsaA Member *

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Accepted Payment Methods *

Client Focus

Clinical Supervision *

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Clinical Supervision Type

Education *

Insurance *

License *

(E.g., LCSW, MD, etc. Enter n/a if not applicable)

Occupation *

PCC PEP Web Subscription *

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PCC Training Analyst and/or Psychoanalytic Psychotherapist

Interested in learning about the following PCC efforts

Please select your degree(s) *

Psychoanalytic Interests

Psychoanalytic Training

Significant Other

Sliding Scale *

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Treatment Modality

Treatment Orientation

Website