Delaware Drug and Alcohol Outpatient Treatment Licensing

Author: A. Ant, CADC-II, Licensing & Accreditation Expert

Disclaimer: This content is provided for general informational purposes only and should not be construed as legal, regulatory, or licensing advice. Requirements change frequently. Consult qualified professionals for guidance specific to your situation.

Apply now: DSAMH licensure application form (PDF, revised 9/7/22) | Questions: DHSS_DSAMH_ProviderEnrollment@delaware.gov, DSAMH Provider Enrollment (email only, no published phone number)

Whether a Delaware outpatient practice needs a state license turns on one phrase. The Division of Substance Abuse and Mental Health (DSAMH) says in its 2026 licensure guideline, DSAMH057, that mental health treatment practices generally don’t need its license, but a program that “substantially engages in treating substance use disorder as a primary driver of the program” does. A therapy group that sees some clients with alcohol problems sits on one side of that line. A clinic built around addiction care sits on the other, and it applies to DSAMH under 16 Del. Admin. Code 6001.

This guide is about ambulatory SUD care for adults: outpatient, intensive outpatient, partial hospitalization and ambulatory withdrawal management. Residential beds are covered in Delaware Drug and Alcohol Inpatient Treatment Licensing, and the statewide overview is Delaware Behavioral Health Licensing.

Who Falls Outside the DSAMH License

The carve-outs below are DSAMH’s own wording, taken from 6001 and its posted policies.

6001 defines an “Agency” as any legal entity “except for an individual practitioner,” and DSAMH057 adds that “Facility does not include the outpatient practice offices of licensed independent practitioners.” The same guideline lists settings that generally don’t need licensure, among them “Federally Qualified Health Care Clinics,” “Primary Care,” embedded integrated care programs designated as MARC programs, and “Mental health treatment practices.” DSAMH’s buprenorphine policy, DSAMH024, carves out practices whose SUD care is buprenorphine prescribing. Its scope is “Any facility that expands their scope of substance use disorder treatment services beyond the prescription of buprenorphine,” so a primary care office that only prescribes stays outside, and one that adds counseling groups for addiction steps inside.

Our reading of those pieces together: a solo licensed counselor’s office doesn’t need a DSAMH license, and a group practice that markets itself as an addiction treatment program almost certainly does. The ground in between is where we’d ask Provider Enrollment for an answer in writing before signing a lease.

Outpatient License Types, Named by ASAM Level

DSAMH057 (revised July 22, 2026) lists the outpatient license types by ASAM level, and the names are what you’ll see on the license.

ASAM level	DSAMH license type
1	Outpatient Services ASAM Level 1
2.1	Intensive Outpatient Program ASAM Level 2.1
1 and 2.1	OP ASAM Level 1 & IOP Services ASAM Level 2.1
2.5	Partial Hospitalization Program ASAM Level 2.5
2 (withdrawal management)	WM Extended On-Site Monitoring ASAM Level 2
2 (withdrawal management)	WM-23HR Extended On-site Monitoring ASAM Level 2

In our experience the combined Level 1 and 2.1 type is the one most new clinics want, since DSAMH057 lists it as a single license type covering standard outpatient and IOP. Partial hospitalization is the odd one. DSAMH’s 2024 version of the guideline matched Level 2.5 to the 6001 category “Co-Occurring Outpatient Services,” and our reading is that a PHP answers to the co-occurring standards in 6001 §16, whose staffing section covers a Medical Director, a Qualified Psychiatric Practitioner and a Clinical Director. The 2024 guideline also put standard Level 2 ambulatory withdrawal management under the 6001 category Ambulatory Detoxification (Amdetox), but it filed the 23-hour extended monitoring service under Residential Detoxification Services. Our reading is that a WM-23HR program should plan for the residential detox standards in 6001 §10.

DSAMH runs a Medicaid certification for many of these services too, a payer step apart from the license that we leave to others.

Clinical Timelines in 6001 §15

The outpatient section of 6001 sets three deadlines your chart audit will test. Each client needs “Documentation of a physical examination by qualified medical personnel within ninety (90) days prior to admission” (§15.1.1.1). The diagnostic assessment is due within 30 days of admission (§15.1.1.2). The recovery plan is due “within thirty (30) days of admission or by the fourth (4th) counseling session, whichever occurs first” (§15.1.1.3). That fourth-session trigger catches IOP programs, where four sessions can come and go inside the first week or so, well before the 30-day mark. Build the plan into intake week and it stops being a finding.

Chapter 56 Will Redraw the Exemptions

Quotations are from the enacted text of 16 Del. C. Chapter 56 on the Delaware Code site. The effects on specific practices are our interpretation.

Delaware’s new behavioral health statute, Senate Substitute 1 for Senate Bill 161 (85 Del. Laws c. 461), was signed August 31, 2026. Act § 12 holds back its licensing and enforcement sections until August 31, 2028, or sooner if the DSAMH Director publishes a Register notice that final regulations are in place, so 6001 and DSAMH057 control for now. Outpatient operators should read the new exemption list in § 5602 closely, because it is worded differently from today’s policies. Exempt outright are “A licensed practitioner in private practice,” programs “exclusively serving children,” and “A licensed professional providing treatment services incidental to the professional’s regular practice.” Other settings are exempt only if the Director chooses, including “A provider organization or program otherwise licensed by this State” and support services such as recovery houses “that do not provide clinical services.”

Two more pieces of the Act matter to outpatient clinics. Section 6, effective immediately, gives DSAMH authority over “licensing requirements for all mental health treatment programs serving individuals who are 18 years old and older.” No such license exists yet, and mental health practices don’t need a DSAMH license today, but a co-occurring clinic should expect that to change once regulations arrive. The outlook for mental health clinics is in Delaware Mental Health Outpatient Licensing. And § 5603 attaches criminal penalties to unlicensed care: intentionally providing treatment services in violation of the license requirement is a class A misdemeanor, and recklessly causing physical injury through unlicensed treatment is a class F felony.

Buprenorphine, Naltrexone and Methadone in Outpatient Care

Office-based buprenorphine is the cleanest path in Delaware, and DSAMH024 (revised February 19, 2025) spells out what it expects. Prescribers need a “current DEA registration that includes Schedule III authority,” new programs need “policies and procedures for checking the Delaware Prescription Monitoring Program (PMP),” and a program has to “contact DSAMH prior to expanding services beyond MOUD treatment.” Federally, DEA’s January 12, 2023 letter says buprenorphine prescriptions “only require a standard DEA registration number.” Delaware also requires its own controlled substance registration, renewed every two years, at each place of practice (16 Del. C. § 4732).

An Amdetox program has a specific orientation duty. 6001 §11.3.1.1 requires clients to be told “The facts concerning the use of buprenorphine, naltrexone, chlordiazepoxide or other detoxification medications” the program dispenses. For naltrexone more broadly, SAMHSA says it “can be prescribed and administered by any practitioner licensed to prescribe medications.” Methadone stays with opioid treatment programs, a separate DSAMH license type plus federal certification, so an outpatient clinic that serves methadone patients needs a working coordination agreement with a licensed OTP rather than a license of its own. We found no 6001 provision that requires a non-OTP outpatient program to offer MOUD, but in our experience referral sources notice quickly which clinics turn MOUD patients away.

Opening a Ketamine Clinic in Delaware

Ketamine clinics go unmentioned in Delaware’s statutes and rules. What follows on facility licensing and ownership is our reading of DSAMH’s policies, the Delaware Code and the Professional Service Corporation Act, so have Delaware health care counsel check them against your plan.

Today, an office giving ketamine for depression or PTSD doesn’t fit any facility license we could find. It isn’t an SUD program under 6001, DSAMH057 says mental health treatment practices generally don’t need licensure, and the Division of Health Care Quality (DHCQ) lists no ketamine category among the facility types it licenses. One question we couldn’t settle is whether DHCQ’s Office Based Surgery category reaches IV ketamine given in an office, so ask DHCQ before you buy infusion equipment. The bigger open item is Chapter 56. Once it is implemented, an entity delivering “treatment services … to treat a behavioral health condition” is a program needing a license unless an exemption applies, and the exemption for “A licensed practitioner in private practice” may not reach a clinic owned by a company. We’d plan the business as though a DSAMH license could become necessary by August 2028.

Who Can Own It

We found no Delaware statute, rule or appellate ruling that bars a lay person from owning a medical practice. The Professional Service Corporation Act, 8 Del. C. Chapter 6, does restrict professional corporations: shareholders must be “duly licensed or otherwise legally authorized,” and no stock may go “to anyone other than an individual who is duly licensed” (§§ 603 and 610). Forming a PC is optional under that chapter, though. Our recommended setup is still a physician-owned PC holding the clinical work, the prescribing protocols and the controlled substance registrations, with investors in a management services company that provides space, staff and billing under contract for a flat or cost-based fee rather than one tied to each infusion. We did not confirm whether an APRN may hold PC shares alongside a physician, so put that question to counsel if a nurse practitioner is part of the ownership group.

Registrations and Prescribers

Ketamine is Schedule III (21 CFR 1308.13(c)(7)), so the clinic address needs a DEA registration and a Delaware controlled substance registration, since § 4732(e) requires “A separate registration … at each principal place of business or professional practice.” Doses given in the office don’t go to the PMP. The PMP’s FAQ says “The administration of a drug does not have to be reported to the PMP.” Take-home doses are another matter, and our reading is that they count as dispensing, which the PMP does collect. An APRN can run the prescribing side alone: 24 Del. C. § 1935(a)(1) has the Board of Nursing grant “full-practice and prescriptive authority upon the issuance of an APRN license,” and the old collaborative agreement provision, § 1936, is repealed. Spravato adds federal conditions: the FDA medication guide allows it only in healthcare settings certified in its REMS, with the patient kept under observation for two hours or more after each dose.

If the clinic shares space with a DSAMH-licensed program, give it its own patient records, its own drug stock and its own registrations. The referral side, for a residence that begins a series and passes the resident to a clinic like this one, is covered in the ketamine section of Delaware Drug and Alcohol Inpatient Treatment Licensing.

Who 6001 Puts on an Outpatient Team, and the Payroll

6001 sets the same role ladder for outpatient as for residential: an Administrator, a Clinical Director (a master’s degree plus five years of clinical experience, or a bachelor’s degree with CADC or CCDP certification and five years in substance use treatment), a Clinical Supervisor, Counselor I staff (a full Delaware CADC is one qualifying route), and Counselor II staff supervised at least one hour per 20 hours of client services. A PHP adds the co-occurring medical roles in §16.

At Delaware’s May 2025 median of $56,020 for substance abuse, behavioral disorder, and mental health counselors (BLS OEWS), a modest Level 1 and 2.1 clinic staffed by three counselors under one clinical supervisor and one clinical director runs about $280,100 a year in clinical salaries before benefits. The state’s 25th percentile is $43,760, its 75th is $64,790, and the national median is $59,350. That $280,100 is a high-water mark, and most new Delaware clinics open below it. Supervised trainees are how. The LCDP license requires 1,600 supervised hours among its 3,200 hours of counseling experience (24 Del. C. § 3044), and the associate counselor license (LACMH), good for two years with up to two renewals under § 3033, lets people working toward the LPCMH collect the 1,600 supervised hours § 3032 requires. Put a clinical supervisor in charge of Counselor II staff and associates willing to take lower pay for those hours, and clinical payroll can come in 40 to 60 percent below what the same seats would cost filled with independently licensed staff. If you add Amdetox, one RN can supervise LPNs for the nursing side. We build the staffing plan after you pick your license types.

Accreditation for Outpatient Programs

6001 Part IV gives deemed status to programs accredited by The Joint Commission, CARF or COA, and deemed status supports a two-year license. The bar differs by accreditor: Full Accreditation from the Joint Commission, a Three-Year Accreditation from CARF, or a three- or four-year award from COA (§§17.1.1, 18.1.1, 19.1.1). With deemed status comes a duty to report sentinel events, significant events or hazardous situations (depending on the accreditor) to DSAMH within 24 hours. The inpatient guide walks through the reporting and revocation rules in more detail.

How to Submit Your DSAMH Outpatient Application

Write to DSAMH Provider Enrollment at DHSS_DSAMH_ProviderEnrollment@delaware.gov to start. First-time applicants meet with DSAMH Quality Assurance staff (6001 §4.2.2) after completing the Provider Enrollment Questions and Answers form. The Application for Licensure and/or Certification (revised September 7, 2022) is filed by email with its attachments and a $15 non-refundable check per licensure application, mailed to the Office of the Secretary, Administration, Financial Management Supporting DSAMH, 1901 N. DuPont Highway, New Castle, DE 19720.

Each program at each location needs its own application (6001 §4.2.3). A second office is handled through DSAMH’s Satellite Location Application, DSAMH039A, listed on the Provider Policies and Resources page. DSAMH057 expects applications to be “completed and approved within six (6) months of contact with Provider Enrollment,” and approval starts a 180-day New Provisional license with a compliance audit, extendable once by 90 days (DSAMH020).

What Stalls Delaware Outpatient Applications

The usual stall we see is a group practice that assumed it was exempt, started seeing SUD clients, and then had to apply in a hurry once a referral source asked for its DSAMH license. The other is a policy manual copied from another state that misses the fourth-session recovery plan deadline in §15.1.1.3.

Frequently Asked Questions

Unsure which side of DSAMH’s licensing line your Delaware practice sits on? Ask us where you land.

Sources

• DSAMH, 16 Del. Admin. Code 6001 (posted August 2026): Substance Abuse Facility Licensing Standards, incl. Part IV deemed status (PDF) (checked October 14, 2026)
• Delaware General Assembly, SS 1 for SB 161 (85 Del. Laws c. 461): Bill detail, signed August 31, 2026 (checked October 14, 2026)
• Delaware General Assembly, SS 1 for SB 161, Sections 6, 8, 10 to 12: Enacted bill text and implementation timing (checked October 14, 2026)
• Delaware Code, 16 Del. C. §§ 5601 to 5609: Chapter 56 Subchapter I, definitions, license requirement, exemptions, penalties, fees (checked October 14, 2026)
• DSAMH, DSAMH057 (revised July 22, 2026): SUD treatment licensure and certification guidelines, license types and exemptions (PDF) (checked October 14, 2026)
• DSAMH, DSAMH057 (2024 version): License types mapped to 6001 categories (PDF) (checked October 14, 2026)
• DSAMH, DSAMH020 (revised October 29, 2025): Path to Full Licensure or Certification (PDF) (checked October 14, 2026)
• DSAMH, DSAMH024 (revised February 19, 2025): Buprenorphine Prescribing Practitioners Policy (PDF) (checked October 14, 2026)
• DSAMH, Application for Licensure and/or Certification (revised 9/7/22): Application form, fee and attachments (PDF) (checked October 14, 2026)
• DSAMH, Provider Enrollment Questions and Answers: Pre-meeting form (PDF) (checked October 14, 2026)
• DSAMH: Provider Policies and Resources (contact, satellite and ownership forms) (checked October 14, 2026)
• DEA Diversion Control Division: Dear Registrant letter on the DATA-Waiver, January 12, 2023 (PDF) (checked October 14, 2026)
• SAMHSA: Naltrexone (checked October 14, 2026)
• 21 CFR 1308.13(c)(7), via Cornell LII: Schedule III, ketamine (checked October 14, 2026)
• Delaware Code, 16 Del. C. § 4732: Controlled substance registration, separate registration per location (checked October 14, 2026)
• Delaware Division of Professional Regulation: Prescription Monitoring Program FAQs (checked October 14, 2026)
• 16 Del. C. § 4798, via Justia (verbatim mirror): Prescription Monitoring Program definitions (checked October 14, 2026)
• Delaware Code, 24 Del. C. Chapter 19: Nursing, APRN authority under § 1935 and repealed § 1936 (checked October 14, 2026)
• U.S. FDA: Spravato prescribing information and Medication Guide (PDF) (checked October 14, 2026)
• Delaware Code, 8 Del. C. Chapter 6: Professional Service Corporation Act, §§ 603 and 610 (checked October 14, 2026)
• DHSS, Division of Health Care Quality: Division brochure listing licensed facility types (PDF, March 2022) (checked October 14, 2026)
• Delaware Code, 24 Del. C. Chapter 30: Board of Mental Health and Chemical Dependency Professionals (checked October 14, 2026)
• Delaware Code, 24 Del. C. §§ 3032 and 3033: LPCMH requirements and LACMH term (checked October 14, 2026)
• Delaware Code, 24 Del. C. § 3044: LCDP requirements (checked October 14, 2026)
• U.S. Bureau of Labor Statistics, OEWS May 2025, SOC 21-1018: Delaware occupational employment and wage estimates (checked October 14, 2026)
• U.S. Bureau of Labor Statistics, OEWS May 2025: Substance abuse, behavioral disorder, and mental health counselors (national) (checked October 14, 2026)