Madisen Brooke Moody, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

0704015161 Issued in VA

Practice address

3060 Williams Dr Ste 105
Fairfax, VA 22031-4669

Phone

(571) 587-3941

Fax

(301) 970-4002

NPI assigned

Sep 21, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jun 23, 2026 through Jun 23, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gateway Homes, Inc.

  • Psychiatric Residential Treatment Facility
  • Chesterfield, VA
  • NPI 1154428290
  NPD
• Healthy Foundations, LLC

  dba Healthy Foundations

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bethesda, MD
  • NPI 1740729581
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1194448555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3060 WILLIAMS DR STE 105",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314669",
            "telephone_number": "571-587-3941",
            "fax_number": "301-970-4002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3060 WILLIAMS DR STE 105",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314669",
            "telephone_number": "571-587-3941",
            "fax_number": "301-970-4002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOODY",
        "first_name": "MADISEN",
        "middle_name": "BROOKE",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-21",
        "last_updated": "2026-07-13",
        "certification_date": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "0704015161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard A. Monti Jr., M.D.
• Lino Cueto Montilla, M.D.,F.A.C.O.G.
• Monument-Fairfax, LLC (Revolution Meds Pharmacy)
• Monument-Fairfax, LLC (Revolution Meds Pharmacy)
• Mohammad Moien Monzavi, DDS
• Hailey Nicole Mook, PHARMD
• Esther Moon
• Jonathan Moon, OTD
• Porsha Moon
• Sarah Moon

• Mental Health Counselor in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Mental Health Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.