Thank you for your interest in becoming certified to provide evaluation and treatment for DEEP referred clients. If you have any questions during this process, please feel free to contact our office at (207) 626-8600 and ask to speak with a member of the Case Management Team.
To apply, please complete the following steps:
- Review Chapter 2 (PDF) and the DEEP New Provider Training (PDF)
- Complete an application consisting of the documents outlined in the Agency Providers or Private Providers section.
- Email, fax or mail the completed application to the contact information at the bottom of this page.
- Once received, DEEP will review your information and be in contact if any additional information is needed.
Application Requirements for Agency Providers
To become certified as an agency provider, your organization must be licensed as a substance use agency. The following forms must be submitted to DEEP for certification approval:
- Application and associated elements required by the Application (RTF)
- Letter of Agreement (RTF)
- SUT Data Enrollment Forms
Application Requirements for Private Providers
To become certified as a private provider, please submit the following forms to DEEP for certification approval:
- Application and required elements as directed by the Application (RTF)
- Private Provider Letter of Agreement (RTF)
- Person of Authority Agreement (RTF)
- DEEP Policies and Procedures manual customized to represent your policies and procedures (RTF)
- Clinical Supervision Agreement (RTF) OR Clinical Supervision Agreement (Peer) (RTF)
- SUT Data Enrollment Forms
Please Send Applications to:
- Driver Education and Evaluation Programs
- 41 Anthony Ave
- 11 State House Station
- Augusta, ME 04333-0011
- Fax: (207) 287-3903
- Email: DEEP.OSA@maine.gov