Healthcare Provider Details

I. General information

NPI: 1356855670
Provider Name (Legal Business Name): THE KOHLER GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2017
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13420 REESE BLVD W STE 29
HUNTERSVILLE NC
28078-7925
US

IV. Provider business mailing address

13420 REESE BLVD W STE 29
HUNTERSVILLE NC
28078-7925
US

V. Phone/Fax

Practice location:
  • Phone: 252-758-8636
  • Fax: 252-758-2227
Mailing address:
  • Phone: 252-758-8636
  • Fax: 252-758-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3949
License Number StateNC

VIII. Authorized Official

Name: ASHLEY BOSTIC
Title or Position: PRACTICE MANAGER
Credential:
Phone: 252-758-8636