DEPARTMENT CONTACTS
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DEPARTMENT CONTACTS
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304-746-2918 • 713 Bigley Avenue
Charleston, WV 25302
Fax: 304-746-2919 • E-mail Us

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A Behavioral Health & Social Service Agency Serving West Virginia Children & Families at Home Since 1999.

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REFERRAL FORMS
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You can submit a referral form via the interface below or, for a downloadable/printable version in PDF format, click here.

Home Base Services Referral form

Medicaid Type

General

UNICARE

The Health Plan

WV Family Plan

AETNA

Area of Service

Kanawha Valley Region

Eastern Panhandle

North Central Region

Northern Panhandle

Potomac Highlands Region

Potential Service(s)

Professional Individual Counseling

Supportive Individual Counseling

Substance Abuse Assessment

Mental Health Assessment

Therapeutic Behavioral Services

Psychiatric / Medication Services

Professional Group Counseling

Supportive Grup Counseling

Psychological Testing & Interpretive Report

Skills Training + Development (Para-professional)

Skills Training + Development (Professional)

Questions? Call us: 304-746-2918 • E-mail Us

Family Portrait

Main Ofc.: 304-746-2918 • 713 Bigley Avenue • Charleston, WV 25302 • Fax: 304-746-2919 • E-mail Us