Provider Demographics
NPI:1669409900
Name:VAN WEY, WILLIAM SHANNON (PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SHANNON
Last Name:VAN WEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:VAN WEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:115 NORTH DUKE STREET
Mailing Address - Street 2:SUITE 1-B
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-2010
Mailing Address - Country:US
Mailing Address - Phone:919-286-3453
Mailing Address - Fax:919-286-7033
Practice Address - Street 1:115 NORTH DUKE STREET
Practice Address - Street 2:SUITE 1-B
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2010
Practice Address - Country:US
Practice Address - Phone:919-286-3453
Practice Address - Fax:919-286-7033
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC808103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist