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You for your interest in becoming a direct enrolled Outpatient Mental Health provider with the N.C. Medicaid Program. In order for us to complete the enrollment process, please submit the following: Individual Applicant Outpatient Mental Health Provider Enrollment Application for Individual. N.C. Division of Medical Assistance Medicaid Participation Agreement. Note: All applicants must indicate they have read, understood, and agreed to the rules and regulations governing Medicaid by sig.

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