North Carolina puts the national exam at the start of the ladder. You pass the National Clinical Mental Health Counseling Examination (NCMHCE), the NCE or the rehabilitation counselor exam (CRC) to become a Licensed Clinical Mental Health Counselor Associate (LCMHCA), and that same result carries you to the full LCMHC. The Board of Licensed Clinical Mental Health Counselors then looks for 3,000 hours of supervised practice, 2,000 of them direct counseling, plus a no-fail jurisprudence exam at each licence level.
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Which exam does North Carolina accept for the LCMHC?
Any one of three: the National Counselor Examination (NCE), the National Clinical Mental Health Counseling Examination (NCMHCE) or the Certified Rehabilitation Counselor Examination (CRC). The board’s rules apply that exam requirement to both the associate (LCMHCA) and full (LCMHC) licences, and every level also requires a no-fail jurisprudence exam chosen by the board.
How many hours does North Carolina require?
3,000 hours of supervised clinical mental health practice, including 2,000 hours of direct counseling, gained at no more than 40 hours a week. You need at least 100 hours of clinical supervision, 75 of them individual, and at least one supervision hour for every 40 hours of practice. Practicum and internship hours from your master’s do not count.
Is there a minimum time to complete the hours?
No longer. The board states that the 24-month post-graduate work experience requirement has been removed. The pace is instead limited by the 40-hour weekly cap on countable experience.
What degree does North Carolina require?
For applicants after July 1, 2022, a master’s in counseling or a related field of at least 60 semester hours (or 90 quarter hours) from a CACREP-accredited program. For applications made on or after July 1, 2025, every internship experience must have been completed in a clinical mental health setting.
What does the LCMHC cost, and how do I apply?
The application fee is $238, which includes a $38 criminal background check, and renewal is $200 every two years, due by June 20 of the renewal year. The board accepts no paper applications: you apply through its online application portal, and it quotes four to six weeks to process a complete application.
Test yourself: 3 NCMHCE practice questions
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Question 1
Weighing everything Terry and his wife have described, which diagnostic impression is best supported, and on what grounds?
▸ Why D is the answer
The count and the course both point here: depressed mood and anhedonia plus the neurovegetative and cognitive symptoms, present nearly every day for several months, well past the two-week threshold, add up to a full major depressive episode. The somatic complaints that brought him in are the physical face of that episode, not a separate problem, and the discrete onset marks it as a single episode.
Question 2
Terry has said 'what's the point of getting up' and 'they'd be fine without me,' denied a plan with a shrug, and mentioned rifles in the home. How do you best assess his risk?
▸ Why A is the answer
Passive ideation paired with access to lethal means calls for direct, specific inquiry, not a single screening question answered with a shrug. You ask plainly about how often and how intensely the thoughts come, whether any plan or intent has formed, and what access he has, and you weigh what holds him here, his wife, his children, his own values. That specificity is what turns a vague worry into an accurate read of his danger.
Question 3
Given that Terry has voiced thoughts of death, how do you best handle the limits of confidentiality with him?
▸ Why B is the answer
The limits have to be stated, and the skill is in how. Framing confidentiality and its safety exception as part of a shared effort to keep him well, in plain words, gives him honest information without making disclosure feel dangerous. He can make an informed choice about what to share, and the alliance holds because you have been straight with him.
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