Healthcare Provider Details

I. General information

NPI: 1912797911
Provider Name (Legal Business Name): EBELE P THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12505 KINGSVIEW ST
BOWIE MD
20721-2028
US

IV. Provider business mailing address

12505 KINGSVIEW ST
BOWIE MD
20721-2028
US

V. Phone/Fax

Practice location:
  • Phone: 240-636-8833
  • Fax:
Mailing address:
  • Phone: 240-636-8833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: