creasman counseling, pllc
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Counseling & Medication Management Request
If you are interested in this service, but would like a consultation before scheduling, please complete this form.
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My name is...
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Last
My insurance is
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Select One
Blue Cross Blue Shield (including Anthem and the State Health Plan
Aetna
Cigna/Evernorth
Medcost
Medicare
Tricare
United Healthcare/UMR
Other
I will not be using insurance
Please note that we are not in network with Blue Value, Blue Home, or Blue Local plans.
The first four characters of my insurance member ID are...
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If you are not using insurance, please enter "NA."
I'm seeking help with...
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Depression
Anxiety
Trauma
Career
Relationships
Body Image/Self-esteem
Substance use concerns (myself or family)
Identity (race, gender, ethnicity, sexuality
Parenting
Panic attacks
Perinatal mental health concerns
My child or adolescent
Something else
Check all that apply.
If you checked "something else," please describe:
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Have you ever been diagnosed with or suspect that you have ADHD?
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Yes
No
What county in North Carolina are you located in?
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What is your preferred language?
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English
Spanish
Turkish
I would like to meet...
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In person
Virtually (video telehealth)
Either
For counseling, I'd like to meet with...
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Select One
Adam Brandt
Aisha Al-Qimlass
Beth Vincent
Candice Creasman Mowrey
Katharine Johnson
Kelly King
Melissa Rakowitz
Nikki Birkenstock
Perihan Akcan Aydin (türkçe konuşuyor)
Solana Wild
Taylen Harp
Yailyn Murphy (habla español)
Kristina A Platt
Zac Martin
Brean'a Martin
I'm not sure
For medication management, I'd like to meet with...
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Select One
Michelle Helms, PMHNP-BC, PMH-BC
Tirrini Hill, PMHNP-BC, PMH-BC
First available
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Please enter additional contact info if needed
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Please contact me by...
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Phone
Email
My availability is...
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Mornings (8am-11am)
Afternoons (11am-3pm)
Evenings (3pm-7pm)
Weekends
select all that apply
I have flexibility in my schedule
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Yes
No
Is there anything else you would like us to know or questions you have?
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How did you hear about us?
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Submit
Home
About Us
Providers
Administrative
Leadership
Services
Individual Counseling
Medication Management
Reduced-Fee Counseling
Groups
Clinical Supervision
Resources
FAQs
Rates & Insurance
Good Faith Estimate
Crisis Resources
Practicum & Internship
Podcast
Contact
Client Portal