Provider Demographics
NPI:1184451411
Name:INTREPID CCE, LLC
Entity type:Organization
Organization Name:INTREPID CCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORGANIZOR
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:864-404-7824
Mailing Address - Street 1:840 N OLD PENDLETON RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:SC
Mailing Address - Zip Code:29657-9769
Mailing Address - Country:US
Mailing Address - Phone:864-707-1160
Mailing Address - Fax:
Practice Address - Street 1:6715 STATE PARK RD
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-1831
Practice Address - Country:US
Practice Address - Phone:864-707-1160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty