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Get CA DHCS 6002 2016

Tification Section, MS 2600 PO Box 997413 Sacramento, CA 95899-7413 INITIAL TREATMENT PROVIDER APPLICATION STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF HEALTH CARE SERVICES SUBSTANCE USE DISORDER COMPLIANCE DIVISION, MS 2600 LICENSING AND CERTIFICATION SECTION PO Box 997413 SACRAMENTO, CA 95899-7413 (916) 322-2911 FAX (916) 322-2658 TTY (916) 445-1942 DHCS 6002 (Rev. 06/16) Page 1 of 30 State of California-Health and Human Services Agency INITIAL TREA.

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