Please click on the link if you wish to Apply Online to become a Provider or to add new service levels to an existing certification. The online application will provide all certification applicants with a secure pin. The secure pin will allow applicants to access the application at any time before it is complete and submitted.
The guidance document is also found below. Existing and new applicants should print the guidance document first and to assist them in preparing for the online application process. The guidance document informs applicants what information is necessary and helps to better understand the documentation and certification requirements. Applicants may access the guidance document by clicking apply online to become a provider link or below.
Substance Abuse Treatment Certification Renewal Application (PDF)
Substance Abuse Treatment Certification Renewal Application (word)
Substance Abuse Treatment Certification Application Guidance (PDF)
Substance Abuse Treatment Certification Application Guidance (word)
The renewal application for certified providers that are not adding new levels of service are provided above for your convenience. Please remember that a certification field specialist will send a renewal application to each provider at least thirty (30) days prior to the current expiration date.
Timeline for completion of the online application process:
Please note: Online applicants, for both new and current providers, have 90 days to finalize the online application process; after that timeline expires the system will purge the application. If purging occurs, there is no way to access this information and any applicant with purged information must begin the application process over.
Please contact Mary Jane Shultz at 1-800-535-4006 or via email at email@example.com for information.