Verification of Professional Counseling Experience.pdf - ncblpc 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section I: GENERAL INFORMATION. Fill in the name, title, agency, license type and number, mailing address, business phone, email address, and mobile phone of the person verifying the experience.
3. Proceed to Section II: PROFESSIONAL COUNSELING EXPERIENCE. Enter the name and address of the agency where the professional counseling experience occurred. Confirm if you have personal knowledge of this experience by selecting 'Yes' or 'No'.
4. List only licensed LPC/LMHC experiences with corresponding dates (from and to), total hours of direct client contact, and whether it was full-time or part-time.
5. Finally, ensure that all sections are completed. The verifier must sign and date the form before enclosing it in a sealed envelope for mailing.

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