Becoming a DEEP Provider

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 Patrick Bouchard.

To apply, please complete the following steps:

  1. Review Chapter 2 (PDF) and the DEEP New Provider Training (PDF)
  2. Complete an application consisting of the documents outlined in the Agency Providers or Private Providers section.
  3. Email, fax or mail the completed application to the contact information at the bottom of this page.
  4. Once received, DEEP will review your information and be in contact if any additional information is needed.

Application Material 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 Word | RTF
  • Letter of Agreement Word | RTF
  • WITS New Provider Enrollment Forms Word | PDF

Application Material 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 Word | RTF
  • Letter of Agreement Word | RTF
  • Person of Authority Agreement Word | RTF
  • DEEP Policies and Procedures manual customized to represent your policies and procedures Word | RTF
  • Clinical Supervision Agreement Word | RTF OR Clinical Supervision Agreement (Peer) Word | RTF
  • WITS New Provider Enrollment Forms Word | PDF

For Out of State and Military Providers:

Providers use these forms to validate the completion of treatment for client’s completing treatment outside of Maine or per military requirements in compliance with Chapter 2.

  • Out of State Program Completion Form Word | RTF
  • Military Program Completion Form Word | RTF
Provider Forms (password protected)

Please Send Applications to:
Driver Education and Evaluation Programs
Attn: Patrick Bouchard
41 Anthony Ave
11 State House Station
Augusta, ME 04333-0011
Fax: (207) 287-3903
Email: DEEP.OSA@maine.gov