Genetic Counselor License Verification Form - CDPH Home

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

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download