Interest Form for LPC-S | Visions of Serenity Counseling LLC

Interest Form for Supervision with
Camecia Clark, LPC-S

Thank you for considering clinical supervision with Camecia Clark, LPC-S! I am currently accepting Texas and Louisiana LPC Associates on a case-by-case basis. Please fill out the form below, and I will respond within 3 business days.

First name

Last name

Phone Number

How would you prefer to be contacted? Required

Phone

Master's Program School of Graduation

Month and Year of Graduation

Do you currently have a supervisor? If so, please provide their name and the reason for ending supervision. Or, are you new to applying for your LPC Associate license?

If you are currently an LPC Associate, how many hours of direct and indirect supervision have you accumulated?

Is there any additional information you'd like to share?

Please upload your resume here

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Interest Form for Supervision with Camecia Clark, LPC-S

Interest Form for Supervision with
Camecia Clark, LPC-S