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Get Al Abec Renewal Application 2010-2024

Curity #_________________________ ALC License #___________ 1. Name:_______________________________________________________________ First Middle Last 2. Your name as it appears on your current license: _____________________________ 3. Name of current LPC Supervising Counselor:________________________________ Supervising Counselor’s LPC License Expires:______________________________ PLEASE CHECK THE ADDRESS & PHONE TO BE LISTED AND USED BY THE BOARD TO COMMUNICATE WITH YOU. THIS ADDRESS WILL A.

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