LCMHC Professional Disclosure Statement
Marguerite Reese, MA, LCMHC, LCPC, LPC-MHSP
Office: 910-274-4419
Fax: 910-256-0630
E-mail: marguerite@mwellnessgroup.com
Qualifications
- I am a licensed professional counselor in the state of North Carolina (LCMHC #21187), Illinois (LCPC #180008120), Tennessee (LPC-MHSP #2741) and I have my telehealth license for the state of Florida. I received my Master’s in Counseling from George Washington University in 2008. I have been actively practicing counseling for 18 years.
Counseling Background
- I specialize in adult individual and couple’s therapy. Utilizing Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT) and client centered approaches, I help clients with anxiety (generalized anxiety, OCD, adjustment disorder), depression, self esteem issues, body image, couple’s conflict and resolution and grief.
Session Fees and Length of Service
- Sessions are approximately 55 minutes at a self-pay rate of $165 per session. Sliding scale fees may be considered based on individual need and will be at the agreed upon rate of _______.
- At this time, I am in network with the following types of insurance: Blue Cross Blue Shield, with the exception of Blue Value and Medicare, Cigna and United Healthcare. You are responsible for contacting your insurance provider in order to confirm your mental health and/or substance abuse counseling benefits; they will advise you of your benefit coverage including copayments or coinsurance. Generally, since couples counseling is not covered by insurance companies, I only accept private pay for couples counseling.
- I accept cash, checks, and credit cards (including HSA). A $10 fee is charged for all returned checks. Payment is due at the time of service. Please note that I do not offer services related to court or custody hearings. In the event that I am subpoenaed or must appear in court, the fee is $200 per hour that I would be out of the office (including travel time).
Use of Diagnosis
Some health insurance companies will reimburse clients for counseling services and some will not. In addition, most will require that a diagnosis of a mental-health condition and indicate that you must have an “illness” before they will agree to reimburse you. Some conditions for which people seek counseling do not qualify for reimbursement. If a qualifying diagnosis is appropriate in your case, I will inform you of the diagnosis before we submit the diagnosis to the health insurance company. Any diagnosis made will become part of your permanent insurance records.
Confidentiality
All of our communication becomes part of the clinical record, which is accessible to you upon request. I will keep confidential anything you say as part of our counseling relationship, with the following exceptions: (a) you direct me in writing to disclose information to someone else, (b) it is determined you are a danger to yourself or others (including child or elder abuse), or (c) I am ordered by a court to disclose information.
Complaints
Although clients are encouraged to discuss any concerns with me, you may file a complaint against me with the organization below should you feel I am in violation of any of these codes of ethics. I abide by the ACA Code of Ethics (https://www.counseling.org/resources/ethics).
North Carolina Board of Licensed Clinical Mental Health Counselors
P.O. Box 77819
Greensboro, NC 27417
Phone: 844-622-3572 or 336-217-6007
Fax: 336-217-9450
E-mail: Complaints@ncblcmhc.org
Acceptance of Terms
We agree to these terms and will abide by these guidelines.
Client: ___________________________________________________ Date: ___________
Counselor: ________________________________________________ Date: ___________
