Therapist and Coach Signup Form

Thank you for being a part of this wonderful project to get narcissist abuse victims the help they need. Our goal is to have narcissist abuse resources in every state. We will list narcissist abuse resource providers by state with a “card” version and a pop-up linking to individual pages that will have SEO applied to them, which will allow practitioners to tell victims looking for help a bit more about themselves. We are asking that practitioners write something that describes their abilities, and even how they treat victims. Please write this bio and paste it below. We will get your listing up as soon as we can.

Name (required)
Your title - What Initials do you have after your name?
Image (.jpg, size limit 2megs)
Phone (required)
Email (required)
City (required)
State (required)
Country (if not USA)
Website (required)
Do you take Insurance? If so what insurances?
Do you do online sessions? If so what platform? Do you have limitations? (some people can only do sessions with people in their state)
Practice areas (required)
CodependencyDepressionDissociationDivorceDomestic AbuseDomestic ViolenceFamily TherapyLegal Abuse SyndromeLife CoachMood DisordersNarcissist AbuseNarcissistic PersonalityParenting EducationPersonality DisordersPharmacotherapyPTSDRelationship IssuesSelf EsteemSelf Harm
Your Title (required)
TherapistCoachPsychologistPsychiatristOther
Please give us a short bio to add to your listing (required)

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