Healthcare Provider Details

I. General information

NPI: 1790606887
Provider Name (Legal Business Name): WILLOW TREE COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 WILSON DR
SPARTA NJ
07871-3400
US

IV. Provider business mailing address

50 WILSON DR
SPARTA NJ
07871-3400
US

V. Phone/Fax

Practice location:
  • Phone: 973-903-5431
  • Fax: 973-512-3628
Mailing address:
  • Phone: 973-903-5431
  • Fax: 973-512-3628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: GIA N LEO
Title or Position: CO-OWNER
Credential: LCSW, LCADC
Phone: 862-268-3101