e508 Submission Request

This form is to request submission of your e508 to the NCDMV. Please include the following information in the "message" box below:

Name of facility where you completed treatment

Conviction date (mm/dd/yyyy) **please verify your conviction date before submitting

**You can verify your conviction date by calling the Clerk of Court in the county you were convicted in or the DMV directly at 919.715.7000

Name*

Phone*

Email*

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Behavioral Health Services of Lake Norman

107 Kilson Dr, Suite 202, Mooresville, NC 28117, US

Phone: 704.660.8321 Fax: 704.660.8323

Hours

Mon	09:00 am – 06:00 pm
Tue	12:00 pm – 06:00 pm
Wed	09:00 am – 06:00 pm
Thu	09:00 am – 06:00 pm
Fri	Closed
Sat	09:00 am – 01:00 pm
Sun	Closed

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