AKSAM Provider Locator Survey
This information will be added to the provider locator on the Alaska Society of Addiction Medicine website. All questions are optional.
Name
First Name
Last Name
Title (MD/DO/NP/PA etc)
Clinic Name
Office Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Office Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Scheduling or Intake phone if different
Please enter a valid phone number.
Format: (000) 000-0000.
Website or email for scheduling if applicable
Is a referral required to schedule?
Yes
No
Do you have same-day or walk-in appointments available?
Yes
No
Services offered at your clinic (Select all that apply)
Medications for Alcohol Use Disorder
Buprenorphine for Opioid Use Disorder
Naltrexone for Opioid Use Disorder
Methadone/ Opioid Treatment Program
Treatment of Stimulant Use Disorder
Treatment for Sedative use disorder
Treatment of Behavioral Addiction
Outpatient Withdrawal Management
Inpatient withdrawal Management
Residential SUD treatment
Crisis Stabilization
Contingency Management
Integrated Behavioral Health Treatment
Peer Support
Case Management/ Social Work
Primary Care
Psychiatry
Comprehensive Pain Management
Traditional Healing/ Integrative Medicine
Women's Health Care/ Contraception
Care for Pregnant People
Care for Adolescents
Gender Affirming Care
HIV Treatment or PrEP
Naloxone Distribution
Syringe Access
Mobile Services/ Street Medicine
Telemedicine
Other services offered
Payors Accepted
Medicaid
Medicare
VA Choice
IHS/Alaska Native Benefits
Private Insurance
Sliding Scale
What ASAM level of care does your facility provide if applicable?
Submit
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