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DOB Client Legal Guardian/Relationship to Client SSN Pay Source Admission Date SLC HCA Southern Light Counseling CD Vendor 002344001 SLC NPI 1346513744 Provider Clin Clinical Supervisor H. C. Case Manager RST Worker Referring County Property of SLC Copying without permission is prohibited Treatment Plan Update Other Agency Involved Contact/Name/Credentials Plan to Coordinate Services Attend Scheduled FST Written Reports Phone Calls upon request or as needed Session Notes weekly Clinical...
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