Organization
MAIN STREET CLINICAL ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON VAN WEY PHD (TREASURER)
(919) 286-3453
Entity
Organization
Contact information
Practice address
3326 DURHAM CHAPEL HILL BLVD., BLDG. C, SUITE 230, DURHAM, NC 27707-2600
(919) 286-3453
(919) 286-7033
Mailing address
3326 DURHAM CHAPEL HILL BLVD., BLDG. C, SUITE 230, DURHAM, NC 27707-2600
(919) 286-3453
(919) 286-7033
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Enumeration date
06/26/2006
Last updated
07/11/2019
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