Healthcare Provider Details

I. General information

NPI: 1437954559
Provider Name (Legal Business Name): CONSTANCE T PRINCESS EBOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9675 MUIRKIRK RD
LAUREL MD
20708-2601
US

IV. Provider business mailing address

6930 GREENVALE PKWY
HYATTSVILLE MD
20784-1555
US

V. Phone/Fax

Practice location:
  • Phone: 240-481-6274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: