top of page

Home
About
Contact
More

Use tab to navigate through the menu items.

Let's Connect

Contact

If you contact me I may be in a session. I respond at my earliest convience via email (balanceandbloom@yahoo.com). Please be sure to indicate the phone number where you can be reached immediately and I will call you back as soon as possible. For an immediate mental health emergency, please dial 911.

Danielle Williams, LCSW-C, LICSW

Phone

(443) 264-4684

Email

balanceandbloom@yahoo.com

First Name

Last Name

Email

Phone

Message

Thanks for submitting!

Client Referral Form

Referral Date

First name*

Last name*

Address*

Birthday

Month

Day

Year

SSN #:*

Email*

Phone*

Sex

Male

Female

Race*

African - American

Caucasian

Other

Reason for Referral (check all that apply)

Change in mood

Change in personality

Withdraw

Impulsive

Change in physical appearance

Obsessive/Compulsive

Sensory issues

Other

Assessment Date*

Month

Day

Year

Initial Complaint*

Depressed

Anxious

Trauma/Grief

Social pressures

Insomnia

Irritatable/Angry

Meds*

Payor Source*

Medicaid

Medicare

Self-Pay

Private Insurance

VIRTUAL SERVICES ONLY

123-456-7890

Monday 5:00pm - 9:00pm

Tuesday 5:00 - 9:00pm

Wednesday 5:00pm - 9:00pm

Thursday 5:00pm - 9:00pm

Friday Closed

Saturday 9:00am - 3:00pm

123-456-7890

If you contact me I may be in a session. I respond at my earliest convience via email (balanceandbloom@yahoo.com). Please be sure to indicate the phone number where you can be reached immediately and I will call you back as soon as possible. For an immediate mental health emergency, please dial 911.

Danielle Williams, LCSW-C, LICSW

Business Hours

bottom of page