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Reset FormPrint FormSelect CountyCOUNTY, WEST VIRGINIAIN THE CIRCUIT COURT OF IN RE:Case No.: 2023 [Name of Licensed Independent Clinical Social Worker, Advanced Nurse Practitioner with Psychiatric
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The name of a licensed independent refers to the official name registered with a relevant licensing authority for a professional who operates independently.
Individuals who hold a license to practice independently in their professional field are required to file the name of the licensed independent.
To fill out the name of the licensed independent, complete the required forms provided by the licensing authority ensuring that all details match the official registration.
The purpose of the name of the licensed independent is to officially identify the practitioner and ensure accountability and transparency in their professional practice.
The information that must be reported includes the full name of the licensed independent, license number, and any relevant details about their practice or business.
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