This page is for operators, clinical leaders, and investors opening, expanding, relocating, or maintaining a licensed behavioral health or substance use disorder program in Virginia.

Table of Contents

Additional Virginia Licensing Guides

Virginia Licenses by Service, and Inspects Every Program Every Year

Accreditation won’t buy you a lighter DBHDS inspection schedule here, and that’s worth budgeting around.

The Department of Behavioral Health and Developmental Services (DBHDS) licenses behavioral health and substance use disorder providers under 12VAC35-105, and the license is organized around services, not buildings. Section 12VAC35-105-30 names 33 licensed services, and each one you run has to be approved by name. A provider with a Level 3.5 residential program and a substance abuse outpatient track needs both services on its license, and under § 37.2-411 inspectors look at each of them at least once a year.

Virginia has no accreditation-based license and no regulation that reduces its own inspection for accredited providers. Code of Virginia § 37.2-411 and 12VAC35-105-70 require at least one unannounced inspection of every licensed service every year, CARF, Joint Commission, or COA accreditation notwithstanding. That could change someday. A 2023 law (Acts of Assembly chapter 491, House Bill 2255, with a companion Senate Bill 1155 carrying the same directive, enacted as chapter 492) told DBHDS to consider “how relief from licensing requirements may be authorized for providers that are accredited by recognized national accreditation bodies,” which is what people mean by deemed accreditation. The workgroup’s November 1, 2023 report offered only draft recommendations, and the option with the most support was more study. The same report noted that annual inspections are tied to provisions of Virginia’s DOJ Settlement Agreement, which DBHDS said it can’t change by regulation while those provisions are in effect. No deemed-accreditation rule has been adopted, so we tell clients to plan around today’s inspection schedule.

One more fact shapes a Virginia plan. The Virginia Department of Health runs the Certificate of Public Need (COPN) program, and under § 32.1-102.1:3 it covers hospitals licensed by DBHDS plus any “intermediate care facility established primarily for the medical, psychiatric, or psychological treatment and rehabilitation of individuals with substance abuse.” It also reaches added beds, conversions to psychiatric beds, and new psychiatric or substance abuse treatment services at those facilities. Outpatient, IOP, PHP and lower-intensity residential programs aren’t on the list. The statute doesn’t say which ASAM levels count as an “intermediate care facility.” Our reading is that a medically monitored Level 3.7 inpatient program is the one most likely to be caught, so get VDH’s answer in writing before you sign for a site.

Primary Regulatory Agencies

Straight from DBHDS’s, VDH’s, and the Board of Counseling’s own published descriptions of their roles.

Department of Behavioral Health and Developmental Services (DBHDS), whose Office of Licensing licenses residential, outpatient, inpatient, and community-based behavioral health and SUD services under 12VAC35-105
Virginia Department of Health, Certificate of Public Need Program, which reviews new and expanded DBHDS-licensed hospitals and substance abuse intermediate care facilities, psychiatric and substance abuse service additions, and certain bed and capital projects
Virginia Board of Counseling, which licenses LPCs and LSATPs, certifies CSACs and CSAC-As, and registers qualified mental health professionals (QMHPs)

Virginia Behavioral Health Licensing Snapshot

A reference table, not analysis, drawn from the statutes cited in each row.

Primary SUD Regulator	DBHDS under 12VAC35-105, through its Office of Licensing
Primary Mental Health Regulator	DBHDS under 12VAC35-105, for community programs and for inpatient psychiatric services; a DBHDS-licensed hospital also needs a Certificate of Public Need from VDH
Residential Treatment	SUD residential is licensed by ASAM level (3.1, 3.3, 3.5, and medically monitored 3.7); mental health “Residential treatment” is its own service
Outpatient Treatment	Separate services for substance abuse outpatient, intensive outpatient, and partial hospitalization, and the same three for mental health
Withdrawal Management	No stand-alone license. DBHDS repealed its medically managed withdrawal services article effective June 19, 2025, and the service list has no detox line; in our reading, withdrawal care now sits inside a 3.7 or 4.0 service
Facility License Required	Yes (§ 37.2-405), with each service approved on the provider’s license and a Certificate of Use and Occupancy for each new location
Certificate of Public Need	Required for DBHDS-licensed hospitals and substance abuse intermediate care facilities, and for adding beds or psychiatric or substance abuse services there; outpatient programs are not on the list
National Accreditation	Not required except for medication for opioid use disorder services; brings no reduction in DBHDS inspection (deemed accreditation was studied in 2023, not adopted)
Inspection	At least one unannounced inspection per licensed service every year, regardless of accreditation status
License Term	New services start on a conditional license of up to six months (12 successive months at most with renewals); a full license is issued for one year or three successive years (§ 37.2-410)
License Fee	None found in 12VAC35-105 or on DBHDS’s licensing pages; § 37.2-410 lets the Board set one
Key Regulations	12VAC35-105 (licensing regulations), Code of Virginia Title 37.2 Chapter 4 (DBHDS authority), Title 32.1 Chapter 4, Article 1.1 (Certificate of Public Need)

Which Requirements Apply to Which Virginia Program

Organized this way because DBHDS’s own material doesn’t lay it out program by program.

Program	DBHDS License	Accreditation Required	Certificate of Public Need
Outpatient SUD, including IOP and PHP	Substance abuse outpatient, intensive outpatient, or partial hospitalization (each its own service)	No	No
Residential SUD treatment	Level 3.1, 3.3, 3.5, or 3.7 service	No	Not listed for 3.1 to 3.5; possible for a 3.7 inpatient program (our reading)
Opioid treatment program	Medication for opioid use disorder treatment	Yes, from a federally approved accreditor	No
Outpatient mental health	Mental health outpatient (IOP and PHP licensed separately)	No	No
Community residential mental health	Residential treatment	No	No
Psychiatric hospital	Inpatient psychiatric (DBHDS), plus COPN	No	Yes

Because Virginia writes ASAM levels straight into its service list, a 3.7 program already holds a state license for that level. CARF offers something different on top: an ASAM Level of Care Certification, available for adult residential Levels 3.1, 3.5 and 3.7, built with ASAM to check whether a program actually delivers care the way The ASAM Criteria describe. We found nothing in 12VAC35-105 that requires it, DBHDS doesn’t record it on your license, and CARF’s page lists no withdrawal management certification. Referral partners and payers can look it up themselves in CARF’s provider search under the “ASAM Level of Care 3.7” filter.

Programs Covered

Residential substance use disorder treatment
Outpatient substance use disorder treatment, including intensive outpatient and partial hospitalization
Withdrawal management delivered within a licensed inpatient level of care, with medication for opioid or alcohol use disorder where clinically indicated
Opioid treatment programs licensed as medication for opioid use disorder treatment
Outpatient mental health treatment
Community residential mental health treatment

Key Licensing Requirements

Taken from DBHDS’s own rule text rather than paraphrased secondhand.

Training before you apply. Since November 7, 2025, new applicants for Priority 1 or Priority 2 services must complete DBHDS’s Initial Applicant Orientation and pass a proctored Comprehensive Knowledge Exam with a score of 85% or better. A separate DBHDS memo dated August 26, 2026 is narrower than it sounds. Its mandatory pre-application training applies only to the new behavioral health services (Community Psychiatric Support and Treatment for youth and adults, Coordinated Specialty Care, and Mental Health Center-Based Recovery and Empowerment Center). If you’re applying for one of those, the organization’s Main Authorized Contact has to attend a session (sessions began September 8, 2026). A residential, outpatient or opioid treatment application doesn’t trigger it.
A 90-day clock. Initial and modification applications must be submitted in the DBHDS CONNECT portal within 90 days of starting, or DBHDS closes them and you start over.
The application contents set by § 37.2-405.2: a first-year budget with a revenue plan, funds or a line of credit covering at least 90 days of operating expenses, ownership details, any past sanctions in other states, a description of each service, a staffing plan with credentials and job descriptions, and operating policies.
A place in line. Submitted applications go on a waitlist. Under priority categories effective July 30, 2025, Priority 1 services are assigned within 5 to 10 business days and Priority 2 within 21, while for non-priority services DBHDS promises only that at least one applicant a month moves off the waitlist into policy review.
A Certificate of Use and Occupancy for each new location showing the building is classified for its licensed purpose (12VAC35-105-260).
A plan for the annual unannounced inspection every licensed service undergoes, accreditation or not.
CPR coverage. A 2026 law, § 37.2-405.3 (2026 Acts chapter 836), directs the Board to adopt regulations requiring regular emergency medical simulations and at least one CPR-trained employee on duty at each location where services are delivered. The statute tells the Board to write the rules rather than setting a deadline for providers, but we’d build the coverage into the schedule now.
For a DBHDS-licensed hospital or substance abuse intermediate care facility, a Certificate of Public Need from VDH, which VDH says takes six to seven months to apply for and review.

Frequently Asked Questions

How much does it cost to get licensed in Virginia?

We haven’t found a DBHDS application or license fee in 12VAC35-105 or on DBHDS’s licensing pages (§ 37.2-410 allows the Board to set one), so the state’s own charge isn’t where the money goes. The real cost sits in facility buildout, staff credentialing, and policy development, and outside opioid treatment programs Virginia doesn’t make an accreditation survey part of licensing. Most new outpatient programs budget between $180,000 and $400,000 in total pre-opening investment. Residential programs run considerably higher, and a genuine hospital-level project adds the cost of Certificate of Public Need review before licensing work even begins. Those are our planning ranges, not state-published figures.

How long does Virginia behavioral health licensing take?

A realistic range for an outpatient program is 6 to 10 months from planning to a DBHDS license, and residential programs commonly run 9 to 14 months, largely driven by staffing, buildout, and where your service falls on DBHDS’s priority list. A non-priority service can sit on the waitlist for a while, since DBHDS only commits to pulling at least one of those applicants into review each month. A project that needs a Certificate of Public Need adds that review up front; VDH puts the application and review at six to seven months.

What trips people up most often during Virginia’s licensing process?

Assuming accreditation earns a lighter DBHDS inspection schedule, when Virginia has studied that idea but not adopted it. Others include assuming the Certificate of Public Need only matters for psychiatric hospitals, when the statute also names substance abuse intermediate care facilities, and opioid treatment policies still written to the old rules instead of the MOUD amendments that took effect December 1, 2025 (take-home doses from the first week, telehealth screenings and counseling, and no one-year addiction history requirement for admission).

Do you guarantee Virginia licensure?

We can’t promise an outcome that ultimately rests with a state regulator, and we’d be skeptical of anyone who tells you otherwise. What we can commit to is a program built against DBHDS’s actual current requirements, with the service categorization and staffing sequenced correctly from the start.

How much staff will I need to open a behavioral health program in Virginia?

It depends on service type and census, but a small outpatient program with a clinical director and two to three counselors commonly runs $220,000 to $300,000 a year in clinical payroll before benefits. Virginia’s substance abuse, behavioral disorder, and mental health counselors earn a median of $59,880 a year statewide (BLS OEWS, May 2025), essentially at the national median of $59,350, with the middle half earning between $47,390 and $77,870. Those numbers look intimidating on their own, but almost nobody actually staffs at that level. Virginia’s counselor ladder, governed by the Board of Counseling, starts with the Certified Substance Abuse Counseling Assistant (CSAC-A) and the CSAC Supervisee building hours, moves up to the Certified Substance Abuse Counselor (CSAC), and tops out at the independently practicing LSATP or LPC, reached after a residency as a Resident in Substance Abuse Treatment or Resident in Counseling. A common approach staffs the program with counselors accruing hours under a licensed clinical director, at meaningfully lower wages than an all-independently-licensed roster, and pairs one RN with several LPNs for medical oversight rather than staffing every shift with a registered nurse. The actual staffing matrix and cost estimate, mitigation strategies included, follow once the program model itself is confirmed.

Licensing

Who licenses substance use disorder and mental health programs in Virginia?

DBHDS’s Office of Licensing licenses both under 12VAC35-105, with each service approved separately. That includes psychiatric hospitals, which hold the “Inpatient psychiatric” service; Virginia’s hospital licensing law in Title 32.1 doesn’t apply to institutions DBHDS licenses (§ 32.1-124). The Virginia Department of Health comes in through the Certificate of Public Need, which covers opening a DBHDS-licensed hospital or adding beds to one.

Does Virginia require accreditation before I can be licensed?

For most programs, no. DBHDS doesn’t require CARF, Joint Commission, or COA accreditation for residential, outpatient, or inpatient psychiatric services, and holding it doesn’t change your inspection schedule. Opioid treatment programs are the exception: 12VAC35-105-930 requires a medication for opioid use disorder provider to “maintain accreditation with an entity approved under federal regulations.”

Is Virginia planning to add an accreditation benefit?

Possibly, and it’s worth watching since it could change the whole calculus later. House Bill 2255 (2023) had DBHDS look at relief for nationally accredited providers, and the November 2023 workgroup report landed on further study rather than a rule. DBHDS also flagged that its DOJ Settlement Agreement requires annual inspections, which limits what a regulation could change while those terms stand. Nothing has been adopted since, so track it but don’t plan around it.

Facility

Do I need a physical location before I apply?

Yes. For a new location, 12VAC35-105-260 has you send DBHDS a Certificate of Use and Occupancy showing the building is classified for its proposed licensed purpose, and that approval comes from the building regulatory entity where you’re located, not from DBHDS. Zoning is a local question too, so settle it before you sign a lease.

Does opening a second location change my license?

Yes. Under 12VAC35-105-60 you file a written service modification application at least 30 days ahead, and the new site or service can’t open until the Commissioner approves it. Two catches: a provider still on a conditional license can’t add services or locations at all, and if the service you’re adding is Community Psychiatric Support and Treatment, Coordinated Specialty Care, or a Recovery and Empowerment Center, DBHDS’s August 26, 2026 memo says a modification filed before you finish its pre-application training gets administratively withdrawn.

Does a Certificate of Public Need apply to my facility?

Only if you’re opening or expanding a DBHDS-licensed hospital or a substance abuse “intermediate care facility,” or adding beds, psychiatric beds, or psychiatric or substance abuse services at one. Outpatient programs aren’t covered. Because the statute never defines which ASAM levels make a program an intermediate care facility, check a 3.7 project with VDH’s COPN program (copn@vdh.virginia.gov) before you commit.

Staffing

What credentials do addiction counselors need in Virginia?

The Virginia Board of Counseling licenses the LSATP, which requires a graduate degree and a residency of at least 2,000 hours of face-to-face client contact over no less than 21 months, worked under the title Resident in Substance Abuse Treatment. Below that, it certifies the CSAC (a bachelor’s degree, 240 hours of substance abuse education, and 2,000 supervised hours) and the CSAC-A (a high school diploma or GED, 120 hours of training, and a 180-hour practicum). Counselors gathering CSAC hours register their supervision with the Board as CSAC Supervisees.

What credentials do mental health counselors need?

The same Board licenses the independently practicing LPC; Residents in Counseling log at least 2,000 client-contact hours and 200 hours of supervision over no less than 21 months first. It also registers qualified mental health professionals (QMHPs), a common role in DBHDS-licensed programs, who need a bachelor’s degree, 1,500 hours of supervised experience within five years, and 80 hours of didactic education. Social workers and psychologists are licensed by their own separate boards within the Department of Health Professions.

Do staffing rules differ between inpatient and outpatient programs?

Yes, and the regulations get specific at the higher levels. Each ASAM level in 12VAC35-105 has its own staff criteria. For Level 3.7, section 1480 requires a licensed physician overseeing treatment, a physician, nurse practitioner, or physician assistant available 24 hours a day in person or by phone, 24-hour nursing care with a nursing assessment on admission, and medication available for everyone with opioid or alcohol use disorder. The outpatient levels have their own staff sections, and the staffing plan § 37.2-405.2 requires in your application is where DBHDS first sees how you’ll meet them.

Operations

How does medication for opioid use disorder fit into a Virginia license?

Buprenorphine is the easy part. Congress ended the federal DATA waiver on December 29, 2022, and DEA’s guidance says buprenorphine prescriptions now “only require a standard DEA registration number,” with no patient caps, so a program can offer it on-site or through a prescriber relationship. Methadone is different. Under 21 CFR 1306.07 it can be administered or dispensed for addiction treatment, but not prescribed, by a practitioner separately registered with DEA as a narcotic treatment program. In Virginia that means a DBHDS license for “medication for opioid use disorder treatment,” which 12VAC35-105-930 ties to DEA registration, federal HHS certification, Virginia Board of Pharmacy registration, and accreditation. Before that license issues, § 37.2-406 has DBHDS notify the local governing body and community services board, which get 30 days to comment. Programs without an OTP of their own usually refer to one, and we’d put that arrangement in writing.

Does my DBHDS license have to match the services I deliver?

Yes. Virginia licenses by service, so your program description, your level of care and your clinical staffing plan should all describe the same program. Payer enrollment sits outside the license, and we don’t handle it.

Do recovery residences need a DBHDS license?

Not a clinical license. 12VAC35-260 defines a recovery residence as alcohol-free and illicit-drug-free housing that “does not include clinical treatment services,” and DBHDS keeps a list of certified ones. To be certified, the operator needs a credential, accreditation, or charter from the Virginia Association of Recovery Residences or Oxford House, Inc. Our view is that once a house adds counseling or other treatment on site, it should be looking at a 12VAC35-105 license instead.

Enforcement

What happens if DBHDS finds a citation at an inspection?

Under 12VAC35-105-170 you have 15 business days from the licensing report to submit a corrective action plan, with one extension of up to 10 more business days if you ask before the due date. Each plan names the corrective actions, a completion date, and the person responsible. You then have to carry it out by that date and track whether it worked through your quality improvement program.

Can DBHDS summarily suspend a license?

For group homes and residential facilities, yes. Section 37.2-418 (children) and § 37.2-419.1 (adults) let the Commissioner issue a summary suspension order when conditions or practices pose an immediate and substantial threat to health, safety, and welfare, and a hearing must follow within three business days. Other denials, suspensions, and revocations go through the Administrative Process Act.

Does losing accreditation affect my Virginia license?

For most services, not directly, since Virginia licensure doesn’t depend on accreditation. An opioid treatment program is the exception, because 12VAC35-105-930 makes accreditation a standing condition of the MOUD service. For everyone else, losing it can still affect commercial payer relationships and referral sources even though it doesn’t automatically trigger a DBHDS licensing action.

What’s Included and What Isn’t

What we help with in Virginia

We help behavioral health and SUD operators categorize their program correctly under DBHDS’s per-service licensing structure, align staffing and policies with the annual inspection standard, and confirm whether a specific project needs Certificate of Public Need review.

What falls outside that scope

We don’t handle CMS, Medicare, or Medicaid enrollment and billing matters, and marketing isn’t something we provide directly either. Our focus is licensing, certification, and accreditation, not payer credentialing. If you need marketing help, we’re happy to point you toward people who specialize in it.

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.

Sorting out DBHDS’s per-service licensing for a Virginia program? Let’s talk it through.

Sources

Code of Virginia § 37.2-405: Licenses required (checked October 7, 2026)
Code of Virginia § 37.2-405.2: Application requirements (checked October 7, 2026)
Code of Virginia § 37.2-405.3: Emergency medical simulations and CPR (checked October 7, 2026)
Code of Virginia § 37.2-406: Opioid treatment program local notice (checked October 7, 2026)
Code of Virginia § 37.2-410: License term and fees (checked October 7, 2026)
Code of Virginia § 37.2-411: Annual unannounced inspection (checked October 7, 2026)
Code of Virginia § 37.2-415: Conditional and provisional licenses (checked October 7, 2026)
Code of Virginia § 37.2-418: Denial, revocation, suspension (checked October 7, 2026)
Code of Virginia § 37.2-419.1: Summary suspension, adult facilities (checked October 7, 2026)
Code of Virginia § 32.1-102.1:3: Certificate of Public Need projects (checked October 7, 2026)
Code of Virginia § 32.1-124: Hospital licensing exemptions (checked October 7, 2026)
2023 Acts of Assembly chapter 491 (HB 2255): Licensing review including accreditation relief (checked October 7, 2026)
DBHDS report RD621 (filed under 2023 Acts chapter 492): 2023 Combined Study Workgroup HB2255/SB1155 and SB1544, November 1, 2023 (checked October 7, 2026)
12VAC35-105 chapter: DBHDS licensing regulations, table of contents (checked October 7, 2026)
12VAC35-105-30: Licensed services (checked October 7, 2026)
12VAC35-105-50: Issuance of licenses (checked October 7, 2026)
12VAC35-105-60: Service modification (checked October 7, 2026)
12VAC35-105-70: Onsite reviews (checked October 7, 2026)
12VAC35-105-170: Corrective action plans (checked October 7, 2026)
12VAC35-105-260: Building inspection and classification (checked October 7, 2026)
12VAC35-105-930: MOUD registration, certification, and accreditation (checked October 7, 2026)
12VAC35-105-1055: Medically managed withdrawal services (repealed) (checked October 7, 2026)
12VAC35-105-1480: Level 3.7 staff criteria (checked October 7, 2026)
12VAC35-260-10 and -20: Recovery residence definitions and certification, and 12VAC35-260-30: List of recovery residences (checked October 7, 2026)
2023 Acts of Assembly chapter 492 (SB 1155, Senate companion): Same licensing review directive (checked October 7, 2026)
Virginia Board of Counseling: Professions regulated (checked October 7, 2026)
DBHDS: Licensing Information for Providers (checked October 7, 2026)
DBHDS memo, July 18, 2025: Priority service categories and review timelines (checked October 7, 2026)
DBHDS memo, October 9, 2025: MOUD fast-track amendments (checked October 7, 2026)
DBHDS memo: Initial Applicant Orientation for Priority 1 and 2 services (checked October 7, 2026)
DBHDS memo, August 26, 2026: Mandatory pre-application training (checked October 7, 2026)
VDH: Certificate of Public Need Program (checked October 7, 2026)
18VAC115-20-52: LPC residency (checked October 7, 2026)
18VAC115-30-50, -60, -62, -63: CSAC and CSAC-A requirements (checked October 7, 2026)
18VAC115-60-60 and -80: LSATP degree and residency (checked October 7, 2026)
18VAC115-80-40: QMHP registration (checked October 7, 2026)
Virginia Board of Counseling: CSAC Registration of Supervision (checked October 7, 2026)
DEA Diversion Control: Dear Registrant letter on the end of the DATA waiver (checked October 7, 2026)
21 CFR 1306.07: Administering or dispensing narcotic drugs (checked October 7, 2026)
CARF: ASAM Level of Care Certification and Find a Provider (checked October 7, 2026)
ASAM: Level of Care Certification (checked October 7, 2026)