MEDICARE: KIZUNA COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1679363865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIZUNA COUNSELING LLC

Provider Business Mailing Address
First Line	:	922 MAR WALT DR STE 200
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6703
Country	:	US
Telephone Number	:	850-517-6703
Fax Number	:	850-204-9330

Provider Business Practice Location Address
First Line	:	922 MAR WALT DR STE 200
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6703
Country	:	US
Telephone Number	:	850-517-6703
Fax Number	:	850-204-9330

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	ALINA AYAKO GRIFFIN
Credential	:	LMHC
Telephone Number	:	850-517-4604

Provider Enumeration Date	:	05/09/2025
Last Update Date	:	06/09/2025

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