Healthcare Provider Details

I. General information

NPI: 1992523690
Provider Name (Legal Business Name): EXPANSION COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 08/23/2025
Certification Date: 08/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 WASHINGTON ST STE F
CALISTOGA CA
94515-1573
US

IV. Provider business mailing address

1705 WASHINGTON ST STE F
CALISTOGA CA
94515-1573
US

V. Phone/Fax

Practice location:
  • Phone: 310-734-0593
  • Fax: 707-341-3725
Mailing address:
  • Phone: 310-734-0593
  • Fax: 707-341-3725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARY ZIADEH
Title or Position: CLINICAL DIRECTOR
Credential: LMFT
Phone: 310-734-0593