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Per week Hrs. of individual Hrs. of group Hrs. of family signif. Others Name of Administrative Supervisor Phone Number Description of Caseload of clients with primary and secondary diagnosis of alcohol and drug abuse PART A Continued I AUTHORIZE THE OKLAHOMA BOARD OF LICENSED ALCOHOL AND DRUG COUNSELORS TO SEEK ADDITIONAL INFORMATION ABOUT MY WORK AND COUNSELING SKILLS FROM THE INDIVIDUAL SIGNING THIS VERIFICATION FORM Signature of applicant OBLA...
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