Refer to Us

If your client has consented to a referral, you may call us at 207.773.9931 or use this form. While your email transmission will be encrypted in an effort to protect the confidentiality and security of the information provided, we recommend that you contact us by phone whenever you are communicating more detailed personal information.

Please check one and submit the form — your information will be sent to that facility
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Greater Portland Counseling Center
71 US Route One, Suite E
Scarborough, ME 04074
P: 207-773-9931
F: 207-879-5576

 

Residential Programs Intake
71 US Route One, Suite E
Scarborough, ME 04074
P: 207-467-3369
F: 207-879-5576

 

Kennebuck Counseling Center
65 Portland Rd, Building A Suite 2
Kennebunk, ME 04043
P: 207-467-3369
F: 207-4673413

 

Your email: *

 

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Client name: *

 

Client Date of Birth: *

 

Client Phone #: *

 

Client Insurance Type: *

 

Insurance Provider: *

 

Insurance Phone #: *

 

Insurance ID #: *

 

Social Security # (optional):

 

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