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SCREENING FORM

Referrals

Referral Source

Client Information

Date of Birth
Month
Day
Year

Clinic Address

930 Mary Street Louisville, KY. 40204

Contact

Office: 502-560-9285

GIVENHOPE Hours

Mon - Fri

8:30 am – 4:30 pm

Fax: 1-855-644-3659

Saturday

8:30 am – 12:00 pm

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Tamara N. Givens, LPCC

"I believe that the only courage anybody ever needs is the courage to follow your own dreams." --Oprah Winfrey

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