If you are a provider outside North Carolina who wants to treat a patient located in North Carolina by video or phone, you almost always need a North Carolina license in your profession. The state’s North Carolina telehealth out-of-state licensure rules treat the practice of medicine, nursing, therapy, and other licensed health professions as occurring where the patient is physically sitting at the time of the visit, not where the provider is. The North Carolina Medical Board put it plainly in its March 2024 position statement: “the practice of medicine is deemed to occur where the patient is located.”1NC Medical Board. Position Statement on Telemedicine You don’t have to live in North Carolina, but you do have to be licensed here.
There is no general telehealth registration, courtesy permit, or short-term waiver that lets an out-of-state provider skip full licensure. Emergency practice permits that let out-of-state therapists work in North Carolina during the pandemic expired on July 1, 2021. The NC Marriage and Family Therapy Licensure Board has said practicing in the state without a North Carolina license, including by teletherapy, constitutes “practicing without a license.”2NC Board of Marriage and Family Therapy. Telehealth Update
The Two Narrow Exceptions
North Carolina law and board policy carve out only two situations where an out-of-state physician may reach a patient in the state without holding a North Carolina license.
The first is an occasional provider-to-provider consultation. N.C. Gen. Stat. § 90-18(c)(11) says it is not unlicensed practice for a “nonregistered reputable physician or surgeon” to come into the state, in person or “by use of any electronic or other mediums,” on an irregular basis to consult with a resident North Carolina-licensed physician who stays responsible for the patient’s care.3NC General Assembly. N.C. Gen. Stat. § 90-18 The statute specifically excludes physicians in neighboring states who are “regularly practicing” in North Carolina. Irregular is the key word; a standing arrangement is not a consultation.
The second is episodic follow-up care for a traveling patient. If you have an established relationship with a patient in your home state and that patient is temporarily in North Carolina on vacation, at college, or passing through, the Medical Board allows you to deliver follow-up care by telehealth without a North Carolina license.1NC Medical Board. Position Statement on Telemedicine This covers the college student and the snowbird; it does not cover someone who has moved to North Carolina.
Outside those two situations, full North Carolina licensure is required.
Compacts That Speed Up Getting Licensed in North Carolina
Interstate licensure compacts don’t replace the patient-location rule. They make it faster and cheaper to get the North Carolina license you still need. Whether a compact is available depends entirely on your profession.
Physicians
North Carolina became the 44th member of the Interstate Medical Licensure Compact when Governor Josh Stein signed Session Law 2025-37 (House Bill 67) on July 1, 2025. The North Carolina Medical Board implemented the compact on January 1, 2026. A physician gets a Letter of Qualification from the medical board in their state of principal license, then applies to any other compact state. The costs are a $700 non-refundable fee for the Letter of Qualification, a $38 criminal background check fee, and a $400 fee for the North Carolina license obtained through the compact.4NC Medical Board. Interstate Medical Licensure Compact The compact does not grant blanket cross-border practice authority. You still hold a North Carolina license, and you still follow North Carolina law when the patient is here.
Nurses
North Carolina is a member of the Nurse Licensure Compact. Nurses holding an active, unencumbered multistate license in any member state may practice as an RN or LPN in every other member state without any additional license. Advanced Practice Registered Nurses are not covered. An APRN who wants to deliver telehealth to a patient in North Carolina must hold either a multistate RN license or a North Carolina single-state RN license, and separately satisfy North Carolina’s APRN licensure and approval requirements.5NC Board of Nursing. Position Statement on Telehealth and Telenursing
Psychologists
North Carolina joined the Psychology Interjurisdictional Compact (PSYPACT) in 2020.6The Council of State Governments. Psychology Interjurisdictional Compact A psychologist with an active E.Passport may provide telepsychology to clients in other member states, and PSYPACT also authorizes temporary in-person practice of up to 30 days per calendar year in another compact state.
Professional Counselors
Governor Roy Cooper signed House Bill 791 into law as Session Law 2022-52 on July 7, 2022, bringing North Carolina into the Counseling Compact.7North Carolina General Assembly. House Bill 791 Licensed professional counselors residing in a member state may practice, including by telehealth, in other member states without obtaining a separate license in each one.8Counseling Compact Commission. North Carolina Joins Counseling Compact
Social Workers
Governor Stein signed HB 231 on June 13, 2025, making North Carolina the 29th state to join the Social Work Interstate Licensure Compact.9NASW-NC. Social Work Licensure Compact Is Law in NC Multistate licenses are not yet being issued. Implementation is expected to take 12 to 24 months from the compact’s activation in fall 2024, so clinical social workers cannot yet use it for cross-state telehealth practice.
Physical Therapy, Audiology, and Speech-Language Pathology
North Carolina participates in the Physical Therapy Compact and the Audiology and Speech-Language Pathology Interstate Compact, both of which facilitate cross-state practice, including telehealth, for those professions.10Ward and Smith, P.A. Interstate Licensing Compacts and Universal License Recognition for NC Healthcare Professionals
Going the Other Direction: NC Providers Treating Patients in Other States
The same patient-location logic generally runs the other way. The North Carolina Medical Board’s advice to its own licensees is to check with the medical board in the state where the patient is located, because most states apply the same rule.1NC Medical Board. Position Statement on Telemedicine If that other state is a compact member in your profession, the compact may be the fastest route to the license you need.
A Note on Controlled Substances
Licensure solves the “may I treat this patient” question. Prescribing controlled substances across state lines by telehealth carries a separate federal layer. The DEA and HHS extended the COVID-era telemedicine prescribing flexibilities through December 31, 2026, which allow a DEA-registered practitioner to prescribe Schedule II through V controlled substances by telemedicine without an initial in-person evaluation.11HHS Telehealth. Prescribing Controlled Substances via Telehealth The DEA announced three new proposed telemedicine rules in January 2025, including a Special Registration pathway for ongoing telemedicine prescribing of Schedule III–V substances and an Advanced Telemedicine Prescribing Registration for certain Schedule II medications in specialties such as psychiatry, hospice care, and pediatrics.12DEA. DEA Announces Three New Telemedicine Rules Where state and federal rules differ, follow the more restrictive one.