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Get ND DoT SFN 9997 2023-2024

RTMENT OF TRANSPORTATION 608 E BOULEVARD AVE BISMARCK ND 58505-0750 EMAIL: drs nd.gov The Addiction/Education Program is to submit this completed form within 5 working days following client enrollment and also upon completion/termination of the program. FROM: REGARDING: Licensed Addiction Treatment Program/Counselor/Qualified Professional Patient/Driver's Name Telephone Number Address Date of Birth Address State City ZIP Code Qualified Professional (LAC, PhD, LPCC, LCSW) City State.

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