Genetic Counselor License Verification Form - California
State of California--Health and Human Services Agency
California Department of Public Health
zyxwvu California Genetic Counselor License Verification
Instructions: If you need a verification proving that you have a Genetic Counselor license in good standing with the California Department of Public Health, Genetic Disease Screening Program, you must complete this form and provide any additional paperwork required by the state requesting verification.
You may submit your request by using the "Submit this Request by Email" button provided, fax us at (510) 412-1551 or mail your request to:
California Department of Public Health PSQA/ Genetic Disease Screening Program 850 Marina Bay Parkway, F-175 Richmond CA 94804 Please allow 14-21 Business Days for Processing, Mailing and Delivery
Submit by Email Print
If you have questions or concerns, please email us at: PSQAGroup@cdph.
You may call to inquire about the status of your license verification request only after the 21-day processing period has expired (21 days after you submitted your request) at (510) 412-6212.
Applicant Information: Last Name
First Name
Current California License Number
Email Address
GC
Please Choose State or States for Which You Are Requesting a License Verification
Alabama Connecticut Illinois* Maine Missouri New Mexico*
Oregon
Texas
Wisconsin
Alaska Delaware Indiana* Maryland Montana New York
Pennsylvania
Utah*
Wyoming
Arizona Florida Iowa Massachusetts* Nebraska North Carolina
Rhode Island
Vermont
Other
Arkansas Georgia Kansas Michigan Nevada North Dakota South Carolina Virginia
California Hawaii Kentucky Minnesota New Hampshire Ohio*
South Dakota
Washington*
Colorado Idaho Louisiana Mississippi New Jersey Oklahoma
Tennessee*
West Virginia
* May require additional forms from that state agency; please contact them directly before submitting your request.
This service is free.
CDPH 4491 (4/18)
California Department of Public Health, Genetic Disease Screening Program 850 Marina Bay Parkway, Richmond, CA 94804 (510) 412-1502 (510) 412-1551 FAX CDPH Homepage
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