License Application Procedure

In order to apply for a license with the Division of Health Service Regulation to operate a mental health facility as required under General Statute 122C (PDF, 604 KB), you must do the following:

  1. Complete the application (PDF, 283 KB)
    1. For 24-hour Residential Programs:
      • Take the completed application (not the whole packet) to your local zoning office and obtain zoning approval. Attach the zoning approval letter to the application.
      • Take the completed application (not the whole packet) to your catchment area Local Management Entity (LME) office and obtain a letter of support as per Session Law 2005-276 (PDF, 1.43 MB). Attach LME support letter to the application.
      • Submit items required by DHSR Construction Section listed under Requirements for 24-hour Residential Programs.
      • Include annual fee upon submitting all items.
    2. For Day Programs:
      • Take the completed application (not the whole packet) to your local zoning office and obtain zoning approval. Attach the zoning approval letter to the application.
      • Submit all items listed in Requirements for Day Programs, including approved Fire Marshal's, Sanitation and Building Officials' inspection reports as required.
      • Include annual fee upon submitting all items.
  2. Write a letter briefly describing the services to be offered by the facility.
  3. Develop written policies and procedures for your services/program, but do not submit them with the application, as they will be reviewed at a later date.
  4. Send application with required information to:
    Division of Health Service Regulation
    Mental Health Licensure and Certification Section
    2718 Mail Service Center
    Raleigh, NC 27699-2718
  5. Make check payable to: N.C. Division of Health Service Regulation.

Note: Before construction of a new facility, you must submit blueprints and receive approval from the DHSR Construction Section. For information, contact DHSR Construction at 919-855-2718.

Requirements for 24-hour Residential Programs - Existing Structures

Submit the following:

  1. A floor plan that specifies the following:
    1. All levels including basements and upstairs.
    2. Identification of the use of all rooms/spaces.
    3. Dimensions of all bedrooms, excluding any toilets, bathing areas and closets. Clarify double or single occupancy.
    4. Location of all doors and the dimensions of all exterior doors.
    5. Location of all windows including the dimensions of bedroom windows and sill height of bedroom windows above the finished floor.
    6. Location of all smoke detectors noting whether they are battery operated, wired in the house current with battery backup, and if they are interconnected.
  2. Exterior photos of each side of the building.
  3. Interior photos of the kitchen, living areas, bedrooms, and any other rooms.
  4. Directions from Raleigh or a map from the nearest major highway, street or intersection clearly showing the location of the facility.
  5. Local Zoning Department approval for the proposed use.

Requirements for Day Programs

Submit the following:

  1. A floor plan of the entire building or floor within the building of the space to be licensed that specifies the following:
    1. Identification and dimensions of rooms to be licensed.
    2. Exits from the licensed space and building.
    3. Toilet areas and other required support spaces.
  2. Exterior photos of each side of the building.
  3. Interior photos of the proposed licensed space.
  4. Directions from Raleigh or a map from the nearest major highway, street or intersection clearly showing the location of the facility.
  5. Local Zoning Department approval or verification the facility is classified under building/planning for intended use.
  6. Current local Fire Marshal's Inspection Report for the building.
  7. Current local Sanitation Inspection report if serving any food.
  8. New Construction/Renovation: the local Building Officials approval.
  9. Existing Structure: if this is an existing Business Occupancy building (as classified under the North Carolina state building code) and it is only a change of tenant use (for a program that is classified as 'Business Occupancy use') approval from the local Building Official may not be required. Contact your local Building Official and provide them with a copy of your application to verify if your program is classified as a Business Occupancy and if they need to provide any type of documentation. Note: Any Day Treatment Program for Children and Adolescents cannot be located in a building classified as a Business Occupancy. These programs are required to meet either Group E-Education occupancy or Group I-4 - Child Daycare occupancy under the NCSBC.