South Carolina Mental Health Outpatient 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.

South Carolina’s licensing statute works from a list. S.C. Code 44-7-260(A) names the facilities that “may not be established, operated, or maintained in this State without first obtaining a license” once they care for two or more unrelated persons, and an outpatient mental health clinic is not among them. Facilities for chemically dependent or addicted persons are, and the Code defines one as “a facility organized to provide outpatient or residential services to chemically dependent or addicted persons and their families based on an individual treatment plan.” So a therapy practice treating depression, anxiety or trauma runs on its clinicians’ own licenses, and the question that brings the DPH Bureau of Health Facilities Licensing into the picture is whether the practice organizes services around addiction.

What 44-7-260 Leaves Off Its List

Our reading of the statute and of DPH’s licensed facility pages, neither of which names a mental health clinic.

The behavioral health entries DPH licenses are SUD facilities under R.60-93, hospitals under R.60-16 (psychiatric hospitals included) and crisis stabilization units under R.60-125. Office-based psychotherapy has no category. The exemptions in 44-7-260(B), which 2026 Act No. 146 reenacted, are narrow: infirmaries serving the students of private schools, certain community housing for people with intellectual disabilities, and small homeshare programs designated by the state mental health agency. None mentions a professional office. As we read it, a counseling or psychiatry office is simply outside the list rather than exempted from it. A short call to the bureau at 803-545-4370 before opening costs nothing and puts that reading to the test.

Community Mental Health Centers Belong to the State

Public outpatient mental health care in South Carolina is run by the Office of Mental Health inside the Department of Behavioral Health and Developmental Disabilities. 2025 Act No. 3 created that department and gave the office “jurisdiction over all of the state’s mental hospitals, clinics and centers.” A private practice needs no OMH approval to open, by our reading. Any referral or contract arrangement with OMH or a county authority concerns funding rather than licensure, so it falls outside the license and outside the work we take on.

Adding an Addiction Track Brings R.60-93 Into Play

Requirements below come from R.60-93 and DPH’s outpatient application, form 3295-ENG-DPH (07/2025).

Once a practice is organized to deliver outpatient addiction services on individual treatment plans, our reading is that it has become an Outpatient Facility that DPH licenses under R.60-93. The license fee is $75 a year, plus $50 for each satellite, and satellites have to stay within the home county or one bordering it. An initial inspection adds $450. The application goes to CDAP@dph.sc.gov (the preferred route) or by mail to the Bureau of Health Facilities Licensing, P.O. Box 2046, West Columbia, SC 29171, signed under oath, notarized and accompanied by proof of payment. DPH also wants every owner of 5 percent or more listed, proof of property ownership or a lease, and verification of the administrator’s qualifications, since R.60-93 calls for a full-time administrator whose education reaches at least the bachelor’s level in a related field. No patient can be admitted before the license issues.

The counselor rule suits a mental health practice well. Section 508 of R.60-93 accepts a license in psychology, social work, professional counseling or marriage and family therapy alongside the addiction credentials, and requires every facility to employ at least one counselor holding full certification or licensure. Where R.60-93 stops being clear is the solo clinician who treats a few clients for substance use in individual sessions, since the rule does not say when that becomes a facility. Ask DPH before you advertise a substance use program. The full outpatient SUD process is in South Carolina Drug and Alcohol Outpatient Treatment Licensing.

The Board Behind Your Clinicians’ Licenses

The Board of Examiners for the Licensure of Professional Counselors, Marriage and Family Therapists, Addiction Counselors and Psycho-Educational Specialists, created by S.C. Code 40-75-10, licenses most of the clinicians an outpatient practice hires. To become a licensed addiction counselor, a candidate needs a master’s degree or higher and must pass a board-approved exam. An associate license is issued after education and exam but before the supervised experience is complete, and “An associate who has not completed the requirements for licensure within two years may apply to the board for an extension.” Supervisors need five years in practice.

Two 2024 laws changed the board’s ground rules. 2024 Act No. 189, effective May 21, 2024, brought South Carolina into the Professional Counseling Compact and added a criminal record check for professional counselor applicants. 2024 Act No. 158, effective May 20, 2024, changed renewal and continuing education requirements, with its first three sections applying to license renewal cycles ending after 2025. A clinician renewing for the first time under the new cycle should read the current board requirements rather than the ones they met last time.

Ketamine and Spravato in a South Carolina Office Practice

No South Carolina license, rule or board opinion we found speaks to office-based ketamine for depression, so the conclusions below are ours, drawn from the statutes, opinions and federal sources cited.

No facility license attaches. DPH has no category for an office infusion practice, and an outpatient mental health practice holds no facility license to amend, so as we read it ketamine sits inside the prescribers’ own medical practice. The exception is a practice that also holds an R.60-93 outpatient license, because section 102.O of that rule bars a licensed facility from establishing “new care or services” before DPH authorizes them. That practice should ask DPH first.

Registrations still apply in full. Ketamine is controlled at the federal level as a Schedule III drug (21 CFR 1308.13(c)(7)). The office therefore needs a DEA registration, and the DPH Bureau of Drug Control issues the state Controlled Substances Registration that S.C. Code 44-53-290 requires (questions to (803) 896-0636 or bdc@dph.sc.gov). For the SCRIPTS monitoring program, 44-53-1630 defines a dispenser to exclude “a practitioner or other authorized person who administers these controlled substances,” which by our reading keeps a dose given in the office out of dispenser reporting.

Nursing is the limit most clinics hit. In its sedation guidance, Advisory Opinion #25 of the Board of Nursing puts ketamine on its list of “agents that are primarily used as anesthetics,” which an RN without anesthesia credentials may not give. The only exception we found, a joint opinion of the medical, nursing and pharmacy boards, covers low dose infusions for pain in acute care hospitals. An RN-run IV infusion for depression in an office has no board opinion behind it, in our reading, so the physician gives the dose. Spravato works differently. Its label allows administration only “at healthcare settings certified in the SPRAVATO REMS program” and has a provider watch the patient for two hours or more after each dose, an arrangement an office can manage once it enrolls.

Nurse practitioners prescribe under a physician’s practice agreement. S.C. Code 40-33-34(C) says a licensed NP, CNM or CNS performing medical acts “must do so pursuant to a practice agreement with a physician who must be readily available for consultation,” and Schedule II through V authority rests on that agreement. Before an NP orders ketamine, we would make sure the agreement itself covers it.

Ownership needs a careful look before anyone writes a check. We found no South Carolina statute on the corporate practice of medicine. The Board of Medical Examiners’ advisory opinion says it regulates licensees rather than corporations and expects the licensee to control clinical judgment at all times, and a 1982 Attorney General opinion states that “a corporation cannot lawfully engage in the practice of law, nor in the practice of medicine, surgery or dentistry,” in an opinion that also relies on older court cases we have not read. Referral arrangements carry their own risk under the Provider Self-Referral Act, S.C. Code 44-113-60, which makes it unlawful to “offer, pay, solicit, or receive a kickback” for referring patients. Entity options for a separate clinic are compared in the ketamine section of South Carolina Drug and Alcohol Outpatient Treatment Licensing.

What a South Carolina Outpatient Practice Spends on Clinicians

Pay sits below the national level here. In BLS’s May 2025 OEWS data, the median South Carolina wage in the substance abuse, behavioral disorder and mental health counselor category is $52,370, with $43,070 at the 25th percentile, $65,070 at the 75th and $59,350 as the national median. Three therapists at the state median cost about $157,110 a year in base pay, and the clinical lead and benefits come on top. Few South Carolina practices have to pay that median for every clinician on the schedule. The board’s addiction counselor associate license lets a clinician who has passed the exam keep seeing clients under supervision while finishing supervised experience, and a practice holding an R.60-93 license can also bring on counselors without a credential, under direct on-site supervision, for up to three years while they earn one. A fully licensed clinical lead supervising several associates paid at that stage’s rate typically cuts 40 to 60 percent from the counseling budget compared with an all-licensed roster. If a medication clinic is part of the plan, one RN overseeing LPNs costs less than an all-RN staff. The services you offer and the caseload you expect set the final mix.

Common Missteps for South Carolina Outpatient Practices

The most expensive one is starting substance use groups before checking whether the practice has become an R.60-93 facility, since no patient may be admitted before that license. Another is treating an OMH or county referral arrangement as if it were a license. Smaller but common: building policies from R.61-93 and DHEC references, or sending DPH an outpatient form older than the current 07/2025 version.

Frequently Asked Questions

Planning to add substance use services to a South Carolina therapy practice? Send us the details.

Sources

• S.C. Code Title 44, Chapter 7 (44-7-130, 44-7-260): Chapter 7 (checked October 18, 2026)
• DPH, Facilities for Chemically Dependent or Addicted Persons: SUD facility licensing (checked October 18, 2026)
• DPH, Applications for Licensure and form 3295-ENG-DPH (07/2025): Applications and Form 3295 (PDF) (checked October 18, 2026)
• DPH copy of R.60-93 and the official Chapter 60 text: R.60-93 (PDF) and Chapter 60 (PDF) (checked October 18, 2026)
• DPH, Hospital Licensure: Hospital Licensure (checked October 18, 2026)
• 2025 Act No. 3 (S.2) and 2026 Act No. 146 (H.4189, Section 128 reenacting 44-7-260): Act 3 and Act 146 (checked October 18, 2026)
• S.C. Code Title 40, Chapter 75 (counselor board, 2024 Acts No. 158 and 189): Chapter 75 (checked October 18, 2026)
• DPH, Bureau of Drug Control: Drug Control (checked October 18, 2026)
• S.C. Code Title 44, Chapter 53 (44-53-290, 44-53-1630): Chapter 53 (checked October 18, 2026)
• 21 CFR 1308.13(c)(7), via Cornell LII: Schedule III (checked October 18, 2026)
• S.C. Board of Nursing, Advisory Opinion #25: AO #25 (PDF) (checked October 18, 2026)
• Boards of Medical Examiners, Nursing and Pharmacy, joint advisory opinion on low dose ketamine (July 2020): Joint opinion (PDF) (checked October 18, 2026)
• FDA, Spravato prescribing information and Medication Guide (revised 09/2026): Spravato label (PDF) (checked October 18, 2026)
• S.C. Code Title 40, Chapter 33 (40-33-34, APRN practice agreements): Chapter 33 (checked October 18, 2026)
• S.C. Board of Medical Examiners, Advisory Opinion on Corporate Practice of Medicine: Corporate practice opinion (PDF) (checked October 18, 2026)
• S.C. Attorney General opinion, September 8, 1982: AG opinion (PDF) (checked October 18, 2026)
• S.C. Code Title 44, Chapter 113 (44-113-60): Chapter 113 (checked October 18, 2026)
• U.S. Bureau of Labor Statistics, OEWS May 2025, SOC 21-1018: South Carolina and National (checked October 18, 2026)