Healthcare Provider Details

I. General information

NPI: 1699091694
Provider Name (Legal Business Name): JEANNINE LAVONNE HINDS M.D., LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JEANNINE LAVONNE DANDRIDGE

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 N SCOTTSDALE RD STE 280
SCOTTSDALE AZ
85251-5650
US

IV. Provider business mailing address

8485 E MCDONALD DR # 214
SCOTTSDALE AZ
85250-6335
US

V. Phone/Fax

Practice location:
  • Phone: 312-363-7250
  • Fax: 936-244-4643
Mailing address:
  • Phone: 312-363-7250
  • Fax: 936-244-4643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAC21081
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number48018
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48018
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: