WisHope-Add-or-Update

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* 1. Add or Update Listing?

Add Listing

Update Existing Listing

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* 2. Your Full Name

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* 3. Your Email Address

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* 4. RC ID NUMBER (this ? is for WisHope staff)

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* 5. Listing Organization Info

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Phone Number

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* 6. Organization Website

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* 7. Logo Link Address

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* 8. MENTAL HEALTH

YES

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* 9. S.U.D. ADDICTION

YES

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* 10. M.A.T.

YES

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* 11. DETOX

YES

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* 12. RESIDENTIAL

YES

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* 13. SOBER LIVING

YES

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* 14. HOMELESS SHELTER

YES

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* 15. GENDER

MALE

FEMALE

ALL

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* 16. PARTIAL HOSPITALIZATION

YES

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* 17. INTENSIVE OUTPATIENT

YES

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* 18. OUTPATIENT

YES

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* 19. IN NETWORK W INSURANCE

YES

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* 20. OUT OF NETWORK

YES

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* 21. COUNTY FUNDING

YES

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* 22. TRIBAL

YES

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* 23. MEDICAID

YES

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* 24. MEDICARE

YES

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* 25. VET / TRI CARE

YES

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* 26. SLIDING FEE

YES

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* 27. LGBTQ

YES

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* 28. RELIGIOUS

YES

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* 29. TYPE

OUTPATIENT

RESIDENTIAL

SOBER LIVING

HOMELESS SHELTER

ADOLESCENT

RESOURCE / COMM ORG

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* 30. NOTES

NOTES