Healthcare Provider Details

I. General information

NPI: 1326116617
Provider Name (Legal Business Name): ALPHABET SOUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 LLOYD ST
CARRBORO NC
27510-1824
US

IV. Provider business mailing address

310 LLOYD ST
CARRBORO NC
27510-1824
US

V. Phone/Fax

Practice location:
  • Phone: 919-924-0811
  • Fax: 888-768-9804
Mailing address:
  • Phone: 919-924-0811
  • Fax: 888-768-9804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: LESLIE COUNCIL
Title or Position: ADMIN
Credential:
Phone: 919-924-0811