e-mail address:
Name :
Address:
City:
State :	-- selection -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zipcode:
Phone :
Best way to contact you :
INFORMATION REQUESTED:

Our locations:

20505 Dupont Highway, Unit 1 Georgetown, DE 19947 302-856-1835 Fax 856-1764

Suite 100 ,907 North Dupont Highway Milford, DE 19963 ----------------------- Rehoboth, DE 19971

Links:
For drug and alcohol information:
Join Together
www.jointogether.org
Substance Abuse and Mental Health Administration
www.samhsa.gov
Alcoholics Anonymous
www.aa.org
Narcotics Anonymous
www.na.org

For information on AIDS and HIV:
Delaware HIV Consortium

For information about DUI and Driver licensing concerns:
Division of Motor Vehicles

For information about addiction counseling professionals:
NAADAC - - The Association for Addiction Professionals
www.naadac.org

20505 Dupont Blvd, Unit 1 | Georgetown, DE 19947 | Phone (302) 856.1835 | Fax (302) 856.1784

The Contractor agrees to acknowledge in any communication involving the public, the media, the legislature or others outside of DSAMH that the services provided under the terms of this contract are funded by and are part of the system of public services offered by DSAMH.