MEDICARE: MR. MARCUS TORELL BOYD LPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	15793	NC
2	101YM0800X	Mental Health Counselor	9460	SC
3	101YM0800X	Mental Health Counselor	7915	NC
4	101YM0800X	Mental Health Counselor	LPC014730	GA

General Provider Information

NPI Number	:	1154644821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARCUS TORELL BOYD LPC

Provider Business Mailing Address
First Line	:	9514 GREEN APPLE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-7568
Country	:	US
Telephone Number	:	704-750-5371
Fax Number	:	704-313-9884

Provider Business Practice Location Address
First Line	:	13534 PLAZA ROAD EXT STE 128
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-8921
Country	:	US
Telephone Number	:	704-750-5371
Fax Number	:	704-313-9884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	10/01/2025

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