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Ohio Chemical Dependency Professionals Board 77 South High Street 16th Floor Columbus OH 43215 614-387-1110 phone 614 387-1109 fax www. ocdp.ohio. gov credentialing ocdp.state. oh. us ETHICS COMPLAINT FORM This form is to be used to file an ethics complaint against a Chemical Dependency Counselor CDCA LCDC II LCDC III or LICDC or a Prevention Specialist RA OCPSA OCPS I or OCPS II. Please provide as much detail as possible. Attach additional sheet.

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