Provider Demographics
NPI:1376734863
Name:MAINRIDGE, AMITY LAYNE (LPC)
Entity Type:Individual
Prefix:
First Name:AMITY
Middle Name:LAYNE
Last Name:MAINRIDGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMITY
Other - Middle Name:LAYNE
Other - Last Name:CHOURIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10970
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-0970
Mailing Address - Country:US
Mailing Address - Phone:727-327-7656
Mailing Address - Fax:727-322-2103
Practice Address - Street 1:1437 S BELCHER RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-2829
Practice Address - Country:US
Practice Address - Phone:727-524-4464
Practice Address - Fax:727-538-7272
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health