Healthcare Provider Details

I. General information

NPI: 1588340749
Provider Name (Legal Business Name): COMPREHENSIVE COLLABORATIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 MANCHESTER ST STE 5A
CONCORD NH
03301-5101
US

IV. Provider business mailing address

117 MANCHESTER ST STE 5A
CONCORD NH
03301-5101
US

V. Phone/Fax

Practice location:
  • Phone: 603-606-9357
  • Fax: 603-217-2075
Mailing address:
  • Phone: 603-606-9357
  • Fax: 603-217-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN GIBSON
Title or Position: OWNER
Credential: PHARMD, BCPP
Phone: 603-606-9357