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Services
Adult Services
Child/teen Services
Teletherapy
Providers
Medical Provider
Rabia Jafri, M.D.
Cecelia Clarke, NP-C
Kathleen Visarraga, PMHNP
Madeleine Mercadante, PMHNP-BC
Xia Tan, DNP, PMHNP-BC
Jessica Barkers, MSN, PMHNP
Junealla Lee, MSN, PMHNP-BC
Therapist
Anna Aja, Ed.D.
Bonnie Griffith, LCSW
Cara R. Henry, LCSW
Carolyn F. Tighe, Ed.D., LPC, LMFT
Cheryl Kabana-Ross, ACSW, LCSW
D. Thomas Wessells, Jr., Ed.D., LPC, LMFT
Dalia Nasr, MS
Edward J. Whitacre, LCSW
Ginger E. Rogers, LCSW
Kay Allen, LPC
Kristyn K Neidermeyer, LCSW
Leah Appleton, LPC
Marylyn B.Browman, MSW, LCSW
Nicki/Nicole L. Dandridge, LCSW
Pam Pare, PhD.
Shonda Mcfield – Johnson, LCSW
Savianna Chance, LPC
William Brockman, Ed.D
Psychologists
Barbara Haskins, Psy.D
Dr. Williams
Harriette Barnes-Parker, Ph.D
Forms
Adult Intake Form
Child Intake Form
Coordination of Care with Primary Care Provider
HIPAA Compliance
Release/Request For Information
Telehealth/Telemedicine Consent Form
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Coordination of Care with Primary Care Provider
Insurance companies request that we coordinate care with your primary care provider and any other mental health professionals with whom you are working. While we ask all patients, the decision as to whether about communication occurs is yours. In the areas below please indicate whether you do, or do not, give permission for your Rock Landing Psychological Group clinician to communicate with your other provider(s). If you do give permission, please share their contact information with us on this form. Thank you for completing this form.
Name
Email
Date
Rock Landing Psychological Group Provider
Patient DOB
Permission to release information about my treatment to my Primary Care Provider or other attending physician/provider.
I GIve Permission
I Do Not GIve Permission
Primary Care Provider Name
Phone
FAX
Permission to release information about my treatment to my Mental Health Care Provider.
I GIve Permission
I Do Not GIve Permission
Outside Mental Health Provider Name
Phone
FAX
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Pay Your Bill
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Therapist
Email
*
Phone
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Street Address
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