Licensing Application

Here you will find out how to apply for a state license to provide all other services—with the exception of children’s residential services—for individuals who have or who are at risk of mental illness, serious emotional disturbance, intellectual disabilities, substance use disorders, or brain injury. This includes applicants wanting to become licensed under the Rules and Regulations for the licensing of providers of mental health, mental retardation, and substance abuse services, the Individual and Family Developmental Disabilities Support Waiver and Brain Injury Residential Services.

(Please click here if you are applying for a license to provide children’s residential services.)

REQUIREMENTS FOR A LICENSE

To be licensed by DBHDS to provide services (with the exception of children’s residential services) the application must:

• Submit and receive preliminary approval of the Initial Provider Application [and required attachments].
• Submit, receive approval of, and demonstrate knowledge of required licensing policies, procedures and forms.
• Submit and receive approval of required Human Rights Policies and Procedures.
• Set up an account and request criminal history and central registry background investigations for identified staff as required by Virginia Code §37.2-405 and submit Child Protective Services reference checks.
• Have an on-site review of the physical plant, to include interviews with applicants over the content of their service description and policies and procedures, as well as compliance with other regulations, and copies of forms and sample client and personnel records.

INITIAL PROVIDER LICENSING APPLICATION

The Initial Provider Licensing Application packet is for applicants interested in becoming providers of all other services—with the exception of children’s residential services. In the packet, the new provider applicant will find necessary forms and information needed to successfully apply for a license and manage your program. Obtain your initial application packet in one of two ways:

• Download for free the Initial Provider Application packet documents; or
• Send a completed order form and $35.00 for just the application packet (see tab below on Fees); or

Initial Provider Application Packet – revised 8.19.2021
(At no cost to you, download the entire application packet on individual forms as needed) Licensing Process Overview

CHANGE OF OWNERSHIP APPLICATION FOR LICENSING

Licensing Tools:

Renewal Application– Please use this form to renew a license.

Service Modification Application – Please use this form when you are already licensed and want to want to modify the license or add a service or location.
Please submit the completed form 45 days prior to implementation of the modification.

The Department can only accept payments in the form of a money order. The following licensing services are available to providers and provider-applicants:

• There is a $35.00 fee if you opt to receive the Initial Provider Application packet through the mail.

Please mail the completed order form with a MONEY ORDER to the following address. If you have any questions, you may phone (804) 786-1747.

DBHDS, Office of Licensing
Attention: Office of Licensing
P.O. Box 1797
Richmond, VA 23218-1797

Central Office
1220 Bank Street
Richmond, Virginia 23219

Mailing Address
P.O. Box 1797
Richmond, VA 23218-1797

• Phone: (804) 786-3921
• Voice TDD: (804) 371-8977
• Fax: (804) 371-6638

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