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MADISEN BROOKE MOODY LPC
NPI 1194448555
Counselor - Mental Health in Fairfax, VA

Active since September 21, 2022Opted out of Medicare · through Jun 23, 2028
3060 WILLIAMS DR STE 105, FAIRFAX, VA 22031(571) 587-3941(301) 970-4002 Get Directions Write a Review

NPPES record last updated: July 13, 2026. Verified against the NPPES registry weekly; last sync: September 20, 2026.

Record update history: Jul 13, 2026, Sep 21, 2022 (2 updates tracked since 2022).

About Madisen Brooke Moody Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MADISEN BROOKE MOODY LPC (NPI 1194448555) is an individual mental health provider in Fairfax, Virginia, licensed in Virginia (0704015161) and active in the NPI registry since September 2022. She has opted out of Medicare through June 23, 2028.

NPPES Registry Identity

NPI1194448555
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameMADISEN BROOKE MOODYCredential: LPC
Location Address3060 WILLIAMS DR STE 105Fairfax, VA 22031-4669
Mailing Address3060 Williams Dr Ste 105Fairfax, VA 22031-4669 · (571) 587-3941 · Fax (301) 970-4002
Phone(571) 587-3941
Fax(301) 970-4002
Sole ProprietorYes
Enumeration DateSeptember 21, 2022
Last NPPES UpdateJuly 13, 20262 updates tracked since enumeration
NPPES CertifiedJuly 13, 2026
✔ NPI 1194448555 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in VA · 0704015161
3060 WILLIAMS DR STE 105, Fairfax, VA 22031
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Madisen Brooke Moody Lpc has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from June 23, 2026 through June 23, 2028.

Opt-Out Effective DateJune 23, 2026
Opt-Out In Effect ThroughJune 23, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHRISTINE ROLLINS
Social Worker
3060 WILLIAMS DR STE 105
FAIRFAX, VA 22031
Fairfax County (301) 970-4001
RACHEL OLIVIA COHEN
Counselor (Mental Health)
3060 WILLIAMS DR STE 105
FAIRFAX, VA 22031
Fairfax County (301) 970-4001
MADISON T VOSS
Counselor (Mental Health)
3060 WILLIAMS DR STE 105
FAIRFAX, VA 22031
Fairfax County (301) 970-4001

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Madisen Moody's NPI number?

The NPI number for Madisen Moody is 1194448555. It was assigned to this individual provider in the NPPES registry on September 21, 2022.

Where is Madisen Moody located?

Madisen Moody practices at 3060 Williams Dr Ste 105, Fairfax, VA 22031. The listed phone number is (571) 587-3941.

What is Madisen Moody's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Madisen Moody enrolled in Medicare?

No. Madisen Moody has opted out of Medicare through June 23, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Madisen Moody was last updated on July 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.