Programs and Services in Maine
Office of Substance Abuse
Department of Health and Human Services
*
Required Field
Type of Submission:
New:
Change:
Provider Type:
Co-Occurring Disorder
Deep
Prevention
Treatment
*
Agency Name:
Parent Agency Name:
Mailing Address:
City:
Zip:
Physical Address:
City:
Zip:
Agency Director:
Email:
Clinical Director:
Email:
Contact Person:
Email:
TDS Contact Person:
Email:
Agency Public Email:
Web Address:
Phone Number(s) used to contact your agency:
Telephone 1:
Telephone 2:
TTY:
Available numbers to clients:
Business Hrs.
24 Hrs.
Hrs. Vary
Ans. Machine
Ans. Service
Fax Number:
Select which service(s) your agency is providing:
(for multiple selections hold down
the CNTL key while selecting)
Adventure Based Program
After School Program
Alternative School
Arts Related
C.A.S.T.
Case Management
Co-Occurring Disorder Svcs
Community Building
Consumer Run Residence
Curriculum/School Based
Detoxification
Detoxification Management
Dsat
Environmental Strategies
Extended Care
Extended Shelter
Halfway House
Intensive Outpatient
Lifeskills
Lions Quest
Medication Management
Mentoring
Methadone Detox
Methadone Maintenance
Outpatient Services
Outpatient Therapy
Parenting
Pre-School/Home Visiting
Problem Gambling Counseling
Project Alert
Project Success
Psychological Evaluation
Residential Program
Residential Rehab
S.I.R.P.
Service Learning
Shelter
Skill Building
Strategic Intervention Programs
Teen/Youth Center
Work Place Prevention
Note for Treatment Agencies:
only check services you are
licensed to provide.
Substance Abuse Services License number:
Expiration Date:
DEEP License number:
Expiration Date:
Dual Diagnosis License number:
Expiration Date:
Select which mental health service(s) your agency is licensed by the State to provide:
Case Management
Medication Management
Outpatient Therapy
Psychological Evaluation
Residential Program
(for multiple selections
hold down the CNTL
key while selecting)
Mental Health Services License number:
Expiration Date:
Agency provides a sliding fee scale:
Yes
No
Which population(s) do you serve:
Men
Women
Youth
Agency has bilingual staff:
Yes
No
Which languages:
Agency has staff proficient in sign language:
Yes
No
Agency provides interpreter services for
hearing impaired clients:
Yes
No
Optional: Please provide a short description of services your agency provides to clients.
Other Comments:
Person filling out this form:
Telephone:
Email:
To submit this form online to the Office of Substance Abuse, click "Submit" after completing all applicable information above. This information will be reviewed by staff prior to making a change to the online directory.
